Contemporaneous chronic rejection of multiple allografts with principal pancreatic involvement in modified multivisceral transplantation.
The patient was a 10 yr-old-male with short gut syndrome secondary to Hirschsprung's disease, who underwent a modified (no liver) multivisceral transplant (stomach, pancreas, small and large intestine). The patient experienced malabsorption early in the post-operative course and had been dependent on a combination of enteral and intravenous nutrition. He developed symptoms of bowel obstruction and was suspected to have chronic rejection by an exploratory laparotomy four yr after transplant. Re-transplantation of a multivisceral transplant (stomach, pancreas, liver, small and large intestine) was performed. Microscopic examinations of the explanted allograft organ block revealed varying degrees of chronic rejection in many of the organs but with the pancreatic allograft being affected most severely. The malabsorption symptom following the first transplant may have been caused by the early onset of chronic pancreatic allograft dysfunction. Our case indicates varying severity of chronic rejection among multiple allografts where the pancreatic allograft appeared most susceptible to chronic rejection.
Takahashi
Hidenori
H
Department of Surgery, University of Miami, Miami, Florida, USA.
Delacruz
Victor
V
Sarwar
Shoib
S
Selvaggi
Gennaro
G
Moon
Jang
J
Nishida
Seigo
S
Weppler
Debbie
D
Levi
David
D
Kato
Tomoaki
T
Tzakis
Andreas
A
Ruiz
Phillip
P
D002648:Child; D002908:Chronic Disease; D004386:Duodenum / Q000637:transplantation; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D007420:Intestine, Large / Q000637:transplantation; D007421:Intestine, Small / Q000637:transplantation; D008297:Male; D016377:Organ Transplantation / Q000379:methods*; D016035:Pancreas Transplantation / Q000379:methods; D010182:Pancreatic Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012720:Severity of Illness Index