title: Contemporaneous chronic rejection of multiple allografts with principal pancreatic involvement in modified multivisceral transplantation.
abstract: 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.
authors.affiliation: Department of Surgery, University of Miami, Miami, Florida, USA.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Victor
authors.initials: V
authors.lastname: Delacruz
authors.forename: Shoib
authors.initials: S
authors.lastname: Sarwar
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Debbie
authors.initials: D
authors.lastname: Weppler
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Andreas
authors.initials: A
authors.lastname: Tzakis
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
mesh_terms: 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