Abstract
Utilization of endoscopy to both visualize and selectively biopsy an intestinal allograft has become the standard for early recognition and treatment of intestinal allograft rejection. Despite the widespread acceptance of the need for selective mucosal biopsies, it has not been shown that the histological features of intestinal allograft rejection are either localized or occur as part of a more diffuse phenomenon within a tubular allograft.
To resolve these issues, 88 ileoscopies were performed in 12 small-bowel allograft recipients and mucosal biopsy samples were obtained at 5, 10, and 15 cm, respectively, from the ileal stoma. Each mucosal biopsy was labeled, processed, and evaluated individually for the presence and severity of any evidence for allograft rejection.
The data obtained suggest that intestinal allograft rejection is a diffuse process, and biopsies obtained randomly from an ileal graft are likely to demonstrate evidence of allograft rejection when such is present.
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Abu-Elmagd K, Fung JJ, Reyes J, Casavilla A, Van Thiel DH, Iwaki Y, Warty V, Nikolaidis N, Block G, Nakamura K, Goldbach B, Demetris J, Tzakis A, Todo S, Starzl TE (1992) Management of intestinal transplantation in humans. Transplant Proc 24: 1243–1244
Abu-Elmagd KM, Tzakis A, Todo S, Reyes J, Fung J, Nakamura K, Wright H, Furukawa H, Demetris J, Van Thiel DH, Starzl TE (1993) Monitoring and treatment of intestinal allograft rejection in humans. Transplant Proc 25: 1202–1203
Banner B, Hoffman A, Cai X, Starzl TE, Sneahan DG (1990) Transplantation of the small intestine: the pathologist's perspective. Am J Pathol 14: 109–116
Inshan Clark CC, Cunningham AS, Cram PW, Wood RFM, Lean IA (1990) Lymphocyte infiltration pattern in rat small bowel transplants. Transplant Proc 22: 2460
Jain A, Venkataramanan R, Todo S, Abu-Elmagd K, Fung J, Warty V, Tzakis A, Reyes J, Alessiani M, Starzl TE (1992) Intravenous, oral pharmacokinetics, and oral dosing of FK 506 in small bowel transplant patients. Transplant Proc 24: 1181–1182
Nakamura K, Todo S, Abu-Elmagd K, Reyes J, Tzakis A, Fung JJ, Starzl TE, Demetris AJ (1992) Histologic monitoring of human small bowel allografts with clinical correlation. Transplant Proc 24: 1199–1200
Nakamura K, Nalesnik M, Jaffe R, Todo S, Tzakis A, Abu-Elmagd K, Reyes G, Wright H, Murase N, Van Thiel DH, Fung JJ, Starzl TE, Demetris AJ (1993) Morphological monitoring of human small bowel allografts. Transplant Proc 25: 1212
Schroeder P, Gephardt H, Gundlach M, Hell K, Schweizer E, Hansmann ML, Deltz E (1990) Diagnosis and treatment of graft rejection in experimental and clinical small bowel transplantation. Transplant Proc 22: 2326
Todo S, Tzakis A, Reyes, J, Abu-Elmagd K, Casavilla A, Nour BM, Selby R, Fung JJ, Van Thiel D, Starzl TE (1991) Clinical small bowel or small bowel or small bowel plus liver transplantation under FK 506. Transplant Proc 23: 3093–3095
Todo S, Tzakis AG, Abu-Elmagd K (1992) Cadaveric small bowel and liver transplantation in humans. Transplantation 53: 369–376
Todo S, Tzakis AG, Abu-Elmagd K, Reyes J (1992) Intestinal transplantation in composite grafts or alone. Ann Surg 216: 223–234
Todo S, Tzakis A, Reyes J, Abu-Elmagd K, Casavilla A, Fung JJ, Starzl TE (1993) Intestinal transplantation in humans under FK 506. Transplant Proc 25: 1198–1199
Wright HI, Abu-Elmagd K, Nakamura K, Todo S, Demetris J, Starzl TE, Van Thiel DH (1992) The role of endoscopy in small bowel transplantation. In: Digestive disease week scientific sessions, May 10–13, San Francisco, A-136 (abstract)
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Gurakar, A., Fagiuoli, S., Hassanein, T. et al. Is rejection a diffuse or localized process in small-bowel transplantation?. Surg Endosc 8, 762–764 (1994). https://doi.org/10.1007/BF00593436
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DOI: https://doi.org/10.1007/BF00593436