Rotavirus infection in adult small intestine allografts: a clinicopathological study of a cohort of 23 patients.
Rotavirus enteritis (RVE) is increasingly recognized as a cause of small bowel allograft dysfunction but its significance in adult patients is unknown. We have studied 23 adult small bowel transplant patients aged 19.8-59 years (mean = 38.2 years), who were presented with diarrhea and tested positive for rotavirus by enzyme-linked immunosorbent assay methods. Serial follow-up biopsies, as well as clinical data, are documented and analyzed. These patients were followed up for an average of 168 days (range 33-534 days). Mean time of rotavirus diagnosis from transplant day was 794 days (range 38-2907 days). Self-limited diarrhea lasting 6-13 days (mean = 9 days) was the main presentation. Sixteen (69.6%) patients developed acute cellular rejection either concurrently with (i.e. six patients) or after (10 patients) RVE, often characterized by prominent mucosal plasmacytosis at an average of 22 days (range 0-94 days) from the day RVE was diagnosed. One-third of patients with acute rejection (i.e. five out of 16) required muromonab-CD3 rescue therapy. Two patients experienced graft loss (one from chronic rejection, another from sepsis). Rotavirus infection is a cause of diarrhea in adult small bowel transplant patients. The infection appeared to trigger cellular rejection that was associated with mucosal plasmacytosis, and sometimes required aggressive rescue therapy.
Department of Pathology, University Health Network/ University of Toronto, Ontario, Canada. oyedele.adeyi@uhn.on.ca
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Adeyi
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Costa
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Abu-Elmagd
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Wu
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use; D012400:Rotavirus Infections / Q000473:pathology*
D007166:Immunosuppressive Agents; D016853:Muromonab-CD3