Is rejection a diffuse or localized process in small-bowel transplantation?

Gürakar, Ahmet; Fagiuoli, Stefano; Hassanein, Tarek; Wright, Harlan I.; Balkan, Müjdat; Frezza, Eldo E.; Todo, Satoru; Starzl, Thomas E.; Thiel, David H. Van

doi:10.1007/bf00593436

Cited by 11 publications

(7 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rejection findings are not necessarily uniform throughout the graft [14], but can be regional, affecting distal bowel more than proximal in some instances, as in the instance described above [4,15].…”

Section: Allograft Removal Earlymentioning

confidence: 96%

Pediatric Intestinal Transplantation: The Resected Allograft

et al. 2002

View full text Add to dashboard Cite

We reviewed the clinical and pathologic finding of 22 resected allografts from 19 of the 83 children who underwent a variety of small intestinal transplant procedures in the years 1990-2000 at the Children's Hospital of Pittsburgh. Resections were compared with prior mucosal biopsies because resections allow for evaluation of the entire bowel thickness, including the feeding vessels, and obviate the problems of limited sampling. Partial resections that were done soon after the transplant, or soon after additional surgery, were for surgical problems such as leaks, adhesions, and volvulus. None had biopsy features suggestive of rejection or infection. Partial resections done late (6 months or more) after transplantation were more likely to be related to allograft immune biology; two had a sclerosing peritonitis that was confined to the allograft, and one had an obstructing carcinoma arising in the allograft mucosa. One patient had a localized stricture, demonstrated to be due to graft vascular disease at partial resection, and this patient went on to have the allograft removed a year later for chronic rejection. Early complete allograft enterectomies were for refractory acute cellular rejection, 1-2 months following transplant. One was removed for pancreatitis and liver failure from operative complications. Late allograft enterectomies were generally for chronic rejection, some with residual acute rejection, but there were also a number of patients who had multiple superimposed conditions such as cytomegalovirus, Epstein-Barr virus, and post-transplant lymphoproliferative disorder in various combinations. One had idiopathic scarring and developed an adynamic bowel that remains unexplained. Examination of the resected specimens allows for dissection of the multiple contributions to graft failure, especially the vascular disease that can rarely be seen on mucosal biopsy. An unexpected finding was the impressive hypertrophy of neural elements, nerves, and ganglion cells in many of the patients, the significance of which requires further investigation.

show abstract

Section: Allograft Removal Earlymentioning

confidence: 96%

Pediatric Intestinal Transplantation: The Resected Allograft

et al. 2002

View full text Add to dashboard Cite

show abstract

“…It has recently been reported that endoscopically directed biopsies from macroscopically suspicious areas might lead to earlier recognition of rejection [6]. In this study, we did not want to take a stand on this question but rather to establish the value of mucosal random biopsies.…”

Section: Discussionmentioning

confidence: 95%

“…There are no generally accepted histological criteria for grading rejection in small bowel transplantation as there are for kidney, heart, and lung transplantation (18,20,211. Due to the lack of a grading system, we chose five parameters that have been found to progress during rejection [2,3,6,8,10,12,161. All parameters were scored separately and their mean value (acute rejection index) was used for analysis.…”

Section: Discussionmentioning

confidence: 99%

Value of mucosal biopsies in the monitoring of acute small bowel rejection

Kuusanmãki¹,

Halttunen²,

Pakarinen³

et al. 1997

Transplant Int

View full text Add to dashboard Cite

The value of mucosal biopsies in evaluating small bowel rejection is controversial. In this study, the value of mucosal biopsies was estimated in unmodified porcine small bowel rejection. Ten animals received the distal half of the small bowel as a heterotopic loop (ThiryVella loop). The allografts were followed by proximally and distally harvested full-thickness and mucosal biopsies every other day, starting from the 3rd day and continuing until the grafts became necrotic. The histological parameters in both types of biopsies were semiquantitatively scored from 0 to 3 and compared with each other. The difference in mean values on subsequent days was not remarkable, the results favoring slightly higher values in full-thickness than in mucosal biopsies. Our results suggest that multiple mucosal biopsies are adequate in monitoring morphological changes of small bowel grafts during rejection and that the proximal and distal ileum are similarly affected by acute rejection.

show abstract

“…Therefore, we had to create a working version of grading. We chose five such histologic parameters in mucosa or submucosa that have been shown to change during rejection, 8,9,13,15,[28][29][30] evaluated each of them on a semiquantitative scale and counted the simple mean. This mean was called HI.…”

Section: Discussionmentioning

confidence: 99%