Pathology of human intestinal transplantation.
OBJECTIVE
Intestinal transplantation is a developing therapeutic option for patients with irreversible intestinal failure or short bowel syndrome. The aim of this study was to delineate the histopathology of human intestinal allografts and to define the features of intestinal rejection.


METHODS
The histological features of 3015 endoscopic biopsy specimens and 23 allograft specimens from 62 intestinal recipients were analyzed retrospectively and correlated with clinical findings.


RESULTS
Acute allograft rejection was characterized by a varying combination of crypt injury, mucosal infiltration primarily by mononuclear cells (including blastic lymphocytes), and increased crypt cell apoptosis (more than 2 per 10 crypts). It represented a patchy, often ileal-centered process that could progress to mucosal ulceration; later episodes (more than 100 days posttransplant) tended to show lesser cellular infiltration and greater apoptosis than earlier episodes. Correlation with clinical rejection was good (false-positive rate of 9%; false-negative rate of 26%). Two resected specimens showed obliterative arteriopathy indicative of chronic rejection. In other specimens, preservation injury, cytomegalovirus infection, post-transplant lymphoproliferative disorder, and nonspecific features of active or past mucosal injury could be recognized.


CONCLUSIONS
Mucosal biopsy specimens are a useful means of monitoring intestinal allografts. Based on features validated by clinical correlation, acute rejection can be identified reliably and can be differentiated from the other pathological processes affecting the intestinal allograft.
Lee
R G
RG
Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Nakamura
K
K
Tsamandas
A C
AC
Abu-Elmagd
K
K
Furukawa
H
H
Hutson
W R
WR
Reyes
J
J
Tabasco-Minguillan
J S
JS
Todo
S
S
Demetris
A J
AJ
D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D003586:Cytomegalovirus Infections / Q000209:etiology; D004751:Enteritis / Q000209:etiology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007422:Intestines / Q000293:injuries / Q000473:pathology* / Q000637:transplantation*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011309:Preservation, Biological / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D014180:Transplantation / Q000009:adverse effects