title: Severe acute cellular rejection after intestinal transplantation is associated with poor patient and graft survival.
abstract: Severe acute cellular rejection (ACR) occurs frequently after intestinal transplantation (ITx).
  
  
  
  To evaluate the outcomes and the risk factors for graft failure and mortality in patients with severe ACR after ITx.
  
  
  
  Retrospective study evaluating all ITx recipients who developed severe ACR between 01/2000 and 07/2014. Demographic and histologic data were reviewed.
  
  
  
  20/126 (15.9%) ITx recipients developed severe ACR. Of these 20 episodes, 13 were in adults (median age: 47.1). The median (IQR) time from ITx to severe ACR was 206.5 (849) days. All patients received intravenous methylprednisolone and increased doses of tacrolimus. Sixteen (80%) patients did not respond to initial treatment and required thymoglobulin administration. Moreover, 11 (55%) patients required additional immunosuppressive medications. Six (30%) patients required graft enterectomy. Complications related to ACR treatment were the following: 10 (50%) patients developed bacterial infections, four (20%) patients developed cytomegalovirus infection and four (20%) patients developed post-transplant lymphoproliferative disease. At the end of follow-up, only 3/20 (15%) were alive with a functional allograft. The median patient survival time after diagnosis of severe ACR was 400 days (95% CI: 234.0-2613.0).
  
  
  
  Severe ACR episodes are associated with high rates of graft loss and complications related to treatment.
authors.affiliation: Intestinal Transplant Program, Recanati Miller Transplant Institute, The Mount Sinai Medical Center, New York, NY, USA.|Division of Liver Diseases, Department of Medicine, The Mount Sinai Medical Center, New York, NY, USA.|Division of Liver Diseases, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
authors.forename: Genevieve
authors.identifier: 0000-0001-6397-5567
authors.initials: G
authors.lastname: Huard
authors.affiliation: Intestinal Transplant Program, Recanati Miller Transplant Institute, The Mount Sinai Medical Center, New York, NY, USA.|Division of Liver Diseases, Department of Medicine, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
authors.affiliation: Intestinal Transplant Program, Recanati Miller Transplant Institute, The Mount Sinai Medical Center, New York, NY, USA.|Department of Surgery, Intestinal Rehabilitation and Transplantation Program, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.affiliation: Intestinal Transplant Program, Recanati Miller Transplant Institute, The Mount Sinai Medical Center, New York, NY, USA.|Department of Surgery, Intestinal Rehabilitation and Transplantation Program, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Kishore
authors.initials: K
authors.lastname: Iyer
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
keywords: acute cellular rejection; immunosuppression; intestinal transplantation; outcomes; severe rejection