Skip to main content

Advertisement

SpringerLink
Log in

The challenge of acute rejection in intestinal transplantation

  • Case Report
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

An Erratum to this article was published on 17 February 2013

Abstract

Early diagnosis and treatment of acute cellular rejection (ACR) after intestinal transplantation (ITx) is challenging. We report the outcome of three patients: two presented mild ACR improved with steroids. One presented steroid-resistant severe rejection, improved after rabbit anti-thymocyte globulin (r-ATG), but unfortunately died for encephalitis caused by opportunistic infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Abbreviations

ACR:

Acute cellular rejection

AMR:

Antibody-mediated rejection

CHDF:

Continuous hemodiafiltration

CIIPS:

Chronic idiopathic intestinal pseudo-obstruction syndrome

CIT:

Cold ischemic time

CMV:

Cytomegalovirus

CRBI:

Catheter-related blood infection

DDIT:

Deceased-donor intestinal transplantation

DSA:

Donor-specific antibody

GF:

Growth failure

HD:

Hemodiafiltration

HHV-6:

Human herpesvirus-6

HLA:

Human leucocyte antibody

ITx:

Intestinal transplantation

IVC:

Inferior vena cava

LDLT:

Living-donor liver transplantation

MP:

Methylprednisolone

NID:

Neuronal intestinal dysplasia

PE:

Plasma exchange

PN:

Parenteral nutrition

POD:

Postoperative day

r-ATG:

Rabbit anti-thymocyte globulin

SMA:

Superior mesenteric artery

SMV:

Superior mesenteric vein

TPN:

Total parenteral nutrition

WIT:

Warm ischemic time

References

  1. Abu-Elmagd K, Costa G, Bond GJ et al (2009) Evolution of the immunosuppressive strategies for the intestinal and multivisceral recipients with special reference to allograft immunity and achievement of partial tolerance. Transpl Int 22:96–109

    Article  PubMed  Google Scholar 

  2. Fishbein TM (2009) Intestinal transplantation. N Engl J Med 361(10):998–1008

    Article  PubMed  CAS  Google Scholar 

  3. Hanto DW, Fishbein TM, Wright Pinson C et al (2005) Liver and intestine transplantation: summary analysis, 1994–2003. Am J of Transpl 5(part 2):916–933

    Article  Google Scholar 

  4. OPTN/SRTR annual report (2011). http://www.srtr.org/annual_reports/2010/1014_rec-isc_in.htm. Assessed on 24th Mar 2012

  5. Ueno T, Wada M, Hoshino K et al (2011) Current status of intestinal transplantation in Japan. Transplant Proc 43:2405–2407

    Article  PubMed  CAS  Google Scholar 

  6. Wu T, Bond G, Martin D, Nalesnik MA et al (2006) Histopathologic characteristics of human intestine allograft acute rejection in patients pretreated with thymoglobulin or alemtuzumab. Am J Gastroent 101:1617–1624

    Article  PubMed  CAS  Google Scholar 

  7. Kato T, Mizutani K, Terasaki P et al (2006) Association of emergence of HLA antibody and acute rejection in intestinal transplant recipients: a possible evidence of acute humoral sensitization. Transplant Proc 38:1735–1737

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Ms. Mayumi Kawashima for her secretarial assistance and Ms. Kiyomi Yatsuhashi for proofreading the manuscript.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary, Pancreas, Transplantation and Pediatric Surgery, Kyoto University Hospital, Graduate School of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto city, 606-8507, Japan

    E. Y. Yoshitoshi, A. Yoshizawa, E. Ogawa, M. Kaneshiro, N. Takada, S. Okamoto, Y. Fujimoto & S. Uemoto

  2. Department of Pharmacology, Kyoto University Hospital, Graduate School of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto-shi, 606-8507, Japan

    S. Masuda

  3. Department of Gastroenterology, Kyoto University Hospital, Graduate School of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto-shi, 606-8507, Japan

    M. Matsuura, Y. Nakase & T. Chiba

  4. Department of Pathology, Kyoto University Hospital, Graduate School of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto-shi, 606-8507, Japan

    T. Tsuruyama & H. Haga

  5. Department of Transplant Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    S. Sakamoto

Authors
  1. E. Y. Yoshitoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Yoshizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Kaneshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Takada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Masuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Matsuura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Y. Nakase
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. T. Chiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. T. Tsuruyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. H. Haga
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. S. Uemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Y. Yoshitoshi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshitoshi, E.Y., Yoshizawa, A., Ogawa, E. et al. The challenge of acute rejection in intestinal transplantation. Pediatr Surg Int 28, 855–859 (2012). https://doi.org/10.1007/s00383-012-3110-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-012-3110-x

Keywords

Search

Navigation