TY - JOUR
T1 - Analysis of acute cellular rejection episodes in recipients of primary intestinal transplantation
T2 - A single center, 11-year experience
AU - Selvaggi, G.
AU - Gaynor, J. J.
AU - Moon, J.
AU - Kato, T.
AU - Thompson, J.
AU - Nishida, S.
AU - Levi, D.
AU - Ruiz, P.
AU - Cantwell, P.
AU - Tzakis, A. G.
PY - 2007/5
Y1 - 2007/5
N2 - Intestinal transplantation has evolved over the years with major improvements in patient and graft survival. Acute cellular rejection of the intestine, however, still remains one of the most challenging aspects of postoperative management. We analyzed retrospectively collected data from 209 recipients of primary intestinal grafts at our institution over the past 11 years. A total of 290 episodes of biopsy-proven rejection requiring clinical treatment were analyzed. Rejection episodes doubled in length, on average, with each increasing grade (mild, moderate, severe). We observed increased incidence of overall rejection and particularly severe rejection in recipients of isolated intestinal and liver-intestine grafts in comparison with multivisceral grafts. Two rejection history variables had a significant negative impact on graft survival: the occurrence of a severe rejection episode and a rejection episode lasting ≥21 days. The lower incidence rate of severe rejection in recipients of multivisceral grafts might be due to a combination of increased donor lymphatic tissue and larger load of donor-derived immune competent cells present in the graft. The development of more effective monitoring and treatment protocols to prevent the occurrence of severe and/or lengthy rejection episodes is of critical importance for intestinal graft survival.
AB - Intestinal transplantation has evolved over the years with major improvements in patient and graft survival. Acute cellular rejection of the intestine, however, still remains one of the most challenging aspects of postoperative management. We analyzed retrospectively collected data from 209 recipients of primary intestinal grafts at our institution over the past 11 years. A total of 290 episodes of biopsy-proven rejection requiring clinical treatment were analyzed. Rejection episodes doubled in length, on average, with each increasing grade (mild, moderate, severe). We observed increased incidence of overall rejection and particularly severe rejection in recipients of isolated intestinal and liver-intestine grafts in comparison with multivisceral grafts. Two rejection history variables had a significant negative impact on graft survival: the occurrence of a severe rejection episode and a rejection episode lasting ≥21 days. The lower incidence rate of severe rejection in recipients of multivisceral grafts might be due to a combination of increased donor lymphatic tissue and larger load of donor-derived immune competent cells present in the graft. The development of more effective monitoring and treatment protocols to prevent the occurrence of severe and/or lengthy rejection episodes is of critical importance for intestinal graft survival.
KW - Acute cellular rejection
KW - Impact of rejection
KW - Prognostic factors
KW - Small intestine transplantation
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U2 - 10.1111/j.1600-6143.2007.01755.x
DO - 10.1111/j.1600-6143.2007.01755.x
M3 - Article
C2 - 17359506
AN - SCOPUS:34247326589
SN - 1600-6135
VL - 7
SP - 1249
EP - 1257
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -