Sequential histologic changes in the healing process in small bowel allografts treated for acute cellular rejection.

Abstract

INTRODUCTION:

Acute cellular rejection (ACR) is a common complication seen in small intestinal transplant patients. Once diagnosed, follow-up endoscopy/biopsies may be performed to assess for response to therapy and the pathologist is often asked to determine whether the findings are compatible with treated/resolving or ongoing ACR. To this end, the sequence of resolution of ACR's changes in biopsies is important.

METHODS:

We retrospectively reviewed the clinical histories and hematoxylin and eosin-stained slides from 16 cases of ACR patients who underwent isolated small bowel or combined liver/small bowel/pancreas transplants. Selected cases were new diagnoses of mild ACR with prior negative biopsies in the preceding 2 months, treatment for rejection based on the ACR diagnosis, and biopsies in the following 4 weeks diagnosed as "treated ACR" or "normal." The presence of ACR diagnostic features (epithelial injury, lamina propria [LP] inflammation with resident cell population, and crypt apoptotic body [AB] quantification) were evaluated. A series of 15 age-matched screening intestinal allograft biopsies were used as controls.

RESULTS:

After treatment, epithelial injury as manifested by mucin depletion resolved by 2 week. LP inflammation was significantly reduced by 1 week after therapy, with a marked decrease in activated lymphocytes and eosinophils, and completely returned to control levels by week 3. Apoptosis fell below the diagnostic threshold for rejection (<6 AB/10 crypts) by week 2 and was equivalent to control biopsies at week 3.

CONCLUSION:

Knowledge of the sequence of the resolution of the histologic features of ACR after treatment may provide useful information to pathologists evaluating follow-up biopsies. These data show that both LP inflammation and crypt epithelial injury are reduced by 1 week after anti-rejection therapy and their persistence may signify ongoing rejection.

• Authors: L Liu, R T Fischer, L Xu, G A Talmon
• Journal: Transplantation proceedings (Transplant Proc) Vol. 45 Issue 2 Pg. 643-8 (Mar 2013) ISSN: 1873-2623 [Electronic] United States
• PMID: 23267814 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Mucins

Topics

• Acute Disease
• Adult
• Apoptosis (drug effects)
• Child
• Child, Preschool
• Eosinophils (drug effects, immunology)
• Female
• Graft Rejection (drug therapy, immunology, metabolism, pathology)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infant
• Intestinal Mucosa (drug effects, immunology, metabolism, pathology, transplantation)
• Intestine, Small (drug effects, immunology, metabolism, pathology, transplantation)
• Lymphocytes (drug effects, immunology)
• Male
• Mucins (metabolism)
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Wound Healing (drug effects)
• Young Adult