A Case Report of Acute Cellular Rejection Following Intestinal Transplantation Managed With Adalimumab.
There is a higher incidence of acute cellular rejection (ACR) in small bowel transplantation (SBT) compared with transplantation of other solid organs. Although there are reports on the use of infliximab to successfully treat ACR refractory to other treatments, there are no reports, to our knowledge, regarding the use of adalimumab. We present a case of a female patient with a history of Crohn's disease who underwent an isolated SBT and developed an episode of severe ACR. She was initially treated with methylprednisolone, thymoglobulin, basiliximab, and a dosage adjustment of tacrolimus. Results of repeat endoscopies and biopsies revealed no significant improvement. The patient initiated treatment with adalimumab every 2 weeks for a total of 6 months, in addition to maintenance treatment with prednisone and tacrolimus. Subsequent evaluations showed gradual improvement to normal mucosa and villi without ulceration. A regimen that incorporates adalimumab can thus be used to treat ACR after intestinal transplantation. Larger multicenter studies are needed to show the full efficacy of this therapeutic regimen.
Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.
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B
Rao
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan.
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SM
Jafri
Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan.
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M
Kazimi
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan.
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K
Mullins
Department of Pathology, Henry Ford Hospital, Detroit, Michigan.
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M
Raoufi
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan. Electronic address: msegovi3@hfhs.org.
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MC
Segovia
D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation*
D000893:Anti-Inflammatory Agents; D000068879:Adalimumab