title: Mucosal vascular alterations in isolated small-bowel allografts: relationship to humoral sensitization.
abstract: Acute vascular rejection (AVR) in human small-bowel transplantation is an inadequately characterized entity whose frequency and severity is not well understood. As compared to severe AVR, changes identifying early, mild or evolving AVR are not known. We created a scoring system to evaluate subtle mucosal vascular changes and examined 188 biopsies from 21 patients obtained in the first 3 months post transplant. A majority of patients had a transient rise in vascular injury, often within 30 days of transplant. Small-vessel congestion and erythrocyte extravasation were the most common alterations. The vascular injury score was not related to acute cellular rejection, HLA type or HLA antigen disparities. However, the patients with the vascular changes had significantly higher peak panel reactive antibodies (PRA) and a higher incidence of positive T-cell and B-cell crossmatch. Finally, graft survival was significantly lower in the patients demonstrating the early vascular lesions. These data suggest that the vascular injury is partially associated with humoral presensitization of the recipient and may be a form of acute vascular rejection. Since these vascular changes are frequent, we advocate early post-transplant monitoring to identify and manage potentially high-risk patients.
authors.affiliation: Department of Pathology, University of Miami School of Medicine, Miami, Florida 33136, USA. pruiz@med.miami.edu
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Monica
authors.initials: M
authors.lastname: Garcia
authors.forename: Peter
authors.initials: P
authors.lastname: Pappas
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Violet
authors.initials: V
authors.lastname: Esquenazi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Naveen
authors.initials: N
authors.lastname: Mittal
authors.forename: Deborah
authors.initials: D
authors.lastname: Weppler
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Jose
authors.initials: J
authors.lastname: Nery
authors.forename: Joshua
authors.initials: J
authors.lastname: Miller
authors.forename: Andreas
authors.initials: A
authors.lastname: Tzakis
mesh_terms: D000906:Antibodies / Q000276:immunology; D006084:Graft Rejection / Q000145:classification* / Q000276:immunology / Q000503:physiopathology; D006085:Graft Survival; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D006801:Humans; D007421:Intestine, Small / Q000276:immunology / Q000473:pathology / Q000637:transplantation*
chemical_list: D000906:Antibodies; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II