title: Outcome of exfoliative rejection after isolated intestinal transplantation in an adult: case report.
abstract: A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD 14, endoscopy and histologic examination revealed exfoliative rejection that was not controlled after 14 days of therapy with thymoglobulin. On POD 95, the patient underwent surgery again because of intestinal obstruction. The graft was removed 6 months after transplantation because of continuous severe abdominal pain with weight loss. After enterectomy, the patient developed multiple-organ failure and died on POD day 8. This case underlines the severity of exfoliative rejection and suggests that early enterectomy be performed when the diagnosis is made, before deterioration of clinical status and development of infectious and nutritional complications.
authors.affiliation: Hôpital de l'Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France. yandza.t@chu-nice.fr
authors.forename: T
authors.initials: T
authors.lastname: Yandza
authors.forename: S M
authors.initials: SM
authors.lastname: Schneider
authors.forename: S
authors.initials: S
authors.lastname: Nishida
authors.forename: B
authors.initials: B
authors.lastname: Goubaux
authors.forename: L
authors.initials: L
authors.lastname: Badan
authors.forename: G
authors.initials: G
authors.lastname: Vanbiervliet
authors.forename: M C
authors.initials: MC
authors.lastname: Saint-Paul
authors.forename: G
authors.initials: G
authors.lastname: Bernard
authors.forename: C
authors.initials: C
authors.lastname: Laffont
authors.forename: M
authors.initials: M
authors.lastname: Gari-Toussaint
authors.forename: F
authors.initials: F
authors.lastname: Girard-Pipau
authors.forename: V
authors.initials: V
authors.lastname: Miton
authors.forename: A
authors.initials: A
authors.lastname: Rahili
authors.forename: G
authors.initials: G
authors.lastname: Zeanandin
authors.forename: D
authors.initials: D
authors.lastname: Benchimol
authors.forename: A
authors.initials: A
authors.lastname: Tzakis
authors.forename: J
authors.initials: J
authors.lastname: Gugenheim
authors.forename: X
authors.initials: X
authors.lastname: Hébuterne
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001706:Biopsy; D017809:Fatal Outcome; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D009102:Multiple Organ Failure; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012778:Short Bowel Syndrome / Q000601:surgery*
chemical_list: D000961:Antilymphocyte Serum