title: Early and frequent histological recurrence of Crohn's disease in small intestinal allografts.
abstract: BACKGROUND
  Recurrence of Crohn's disease in small intestinal allografts, although rarely described, can cause serious morbidity and jeopardize graft survival among transplant recipients with Crohn's disease. However, systematic studies to determine the frequency, predictors, and clinical implications of recurrent Crohn's disease have not been reported
  
  
  METHODS
  We analyzed our transplant program's experience with small intestinal allografts in patients with Crohn's disease based on retrospective review of clinical and pathological records and corresponding pathology slides.
  
  
  RESULTS
  Of 67 patients undergoing 70 transplantations between 1998 and 2004, six adults (three males, three females; mean age 48.1 years) had Crohn's disease complicated by short gut syndrome and total parenteral nutrition failure. Four survivors surveyed endoscopically for a mean 29 (range, 20-40) months and underwent a mean 37 endoscopic examinations with biopsies (range, 31-44) while on maintenance immunosuppression. Despite absence of any endoscopic or clinical manifestations of Crohn's disease throughout this period, two patients had granulomatous enteritis characteristic of Crohn's disease in multiple biopsies, one patient in 8/44 examinations (18%) ranging from 34 days to 20 months postoperatively and the other in 6/32 examinations (19%) ranging from 20 days to 22 months postoperatively. No comparable changes occurred in 57 other patients without Crohn's disease followed endoscopically under the same protocol
  
  
  CONCLUSIONS
  Histological recurrence of Crohn's disease may occur in small intestinal allografts despite the absence of endoscopic and clinical disease manifestations. Such recurrences are probably not rare, may occur as early as 3 weeks after transplantation, and do not necessarily portend early clinical recurrence or mandate aggressive therapy to prevent allograft loss.
authors.affiliation: Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, USA. noam.harpaz@msnyuhealth.org
authors.forename: Noam
authors.initials: N
authors.lastname: Harpaz
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
authors.forename: Andres E
authors.initials: AE
authors.lastname: Ruf
authors.forename: Deepti
authors.initials: D
authors.lastname: Shukla
authors.forename: Ye
authors.initials: Y
authors.lastname: Tao
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Fishbein
authors.forename: Berhard V
authors.initials: BV
authors.lastname: Sauter
authors.forename: Gabriel E
authors.initials: GE
authors.lastname: Gondolesi
mesh_terms: D000328:Adult; D017668:Age of Onset; D002648:Child; D003424:Crohn Disease / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000473:pathology