title: Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy.
abstract: Intestinal transplant-associated microangiopathy (i-TAM) is an important complication after allogeneic hematopoietic SCT. From 1997 to 2006, 87 of 886 patients with diarrhea after transplantation received colonoscopic biopsy. i-TAM, GVHD and CMV colitis were diagnosed histopathologically. The median duration from transplantation to the onset of diarrhea was 32 days (range: 9-130 days) and that from the onset of diarrhea to biopsy was 12 days (range: 0-74 days). The median maximal amount of diarrhea was 2 l/day (range: 130-5600 ml/day). Histopathological diagnosis included i-TAM (n=80), GVHD (n=26), CMV colitis (n=17) and nonspecific findings (n=2) with overlapping. Among 80 patients with i-TAM, abdominal pain was a major symptom, and only 11 patients fulfilled the proposed criteria for systemic TAM. Non-relapse mortality (NRM) among patients without resolution of diarrhea was 72% and i-TAM comprised 57% of NRM. NRM was 25% among patients without intensified immunosuppression, but was 52, 79 and 100% among those with intensified immunosuppression before diarrhea, after diarrhea, and before and after diarrhea, respectively. In conclusion, i-TAM is a major complication presenting massive refractory diarrhea and abdominal pain, which causes NRM. Avoiding intensified immunosuppression that damages vascular endothelium until the resolution of i-TAM may improve transplant outcome.
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya 466-8560, Japan. yinamoto@js3.so-net.ne.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Inamoto
authors.forename: M
authors.initials: M
authors.lastname: Ito
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.forename: T
authors.initials: T
authors.lastname: Nishida
authors.forename: H
authors.initials: H
authors.lastname: Iida
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authors.initials: A
authors.lastname: Kohno
authors.forename: M
authors.initials: M
authors.lastname: Sawa
authors.forename: M
authors.initials: M
authors.lastname: Murata
authors.forename: S
authors.initials: S
authors.lastname: Nishiwaki
authors.forename: T
authors.initials: T
authors.lastname: Oba
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authors.initials: M
authors.lastname: Yanada
authors.forename: T
authors.initials: T
authors.lastname: Naoe
authors.forename: R
authors.initials: R
authors.lastname: Ichihashi
authors.forename: M
authors.initials: M
authors.lastname: Fujino
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Morishita
authors.forename: N
authors.initials: N
authors.lastname: Hirabayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Kodera
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authors.lastname: Miyamura
mesh_terms: D000293:Adolescent; D000328:Adult; D003092:Colitis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003967:Diarrhea / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate