Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy.
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.
Inamoto
Y
Y
Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya 466-8560, Japan. yinamoto@js3.so-net.ne.jp
Ito
M
M
Suzuki
R
R
Nishida
T
T
Iida
H
H
Kohno
A
A
Sawa
M
M
Murata
M
M
Nishiwaki
S
S
Oba
T
T
Yanada
M
M
Naoe
T
T
Ichihashi
R
R
Fujino
M
M
Yamaguchi
T
T
Morishita
Y
Y
Hirabayashi
N
N
Kodera
Y
Y
Miyamura
K
K
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