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Small Bowel Transplantation

  • Antonia D’ErricoEmail author
  • Francesco Vasuri
  • Alberto Bagni
Chapter

Abstract

In the last 15 years, intestinal transplantation has become a viable alternative to parenteral feeding in the management of irreversible gastrointestinal failure in children and adults [2, 3]. The graft may consist in the small bowel (isolated intestinal transplant, IITx) or also include liver, colon, pancreas, kidneys and stomach (multivisceral transplant, MVTx). MVTx has improved graft and patient survival so that it is comparable to and in some studies better than IITx [4].

Keywords

Acute Rejection Clostridium Difficile Infection Inflammatory Infiltrate Apoptotic Body Acute Cellular Rejection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ACR

Acute cellular rejection

AMR

Antibody-mediated rejection

CMV

Cytomegalovirus

CR

Chronic rejection

DSA

Donor-specific antibody

EBV

Epstein-Barr virus

GVHD

Graft-versus-host disease

IITx

Isolated intestinal transplantation

MTVx

Multivisceral transplantation

PTLD

Post-transplant lymphoproliferative disease

References

  1. 1.
    Lacaille F. Intestinal transplantation: where are we? Where are we going? Curr Opin Organ Transplant. 2012;17:248–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Ruiz P. How can pathologists help to diagnose late complications in small bowel and multivisceral transplantation? Curr Opin Organ Transplant. 2012;17:273–4. Many reports suggest that MVTx plays a protective role against both acute cellular rejection (ACR) and chronic rejection (CR) compared with ITx, with a substantial decreasing of rejection disease.CrossRefPubMedGoogle Scholar
  3. 3.
    Takahashi H, Kato T, Delacruz V, Nishida S, Selvaggi G, Weppler D, Island E, Moon JI, Levi DM, Tzakis AG, Ruiz P. Analysis of acute and chronic rejection in multiple organ allografts from retransplantation and autopsy cases of multivisceral transplantation. Transplantation. 2008;85:1610–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Tzakis AG, Kato T, Levi DM, Defaria W, Selvaggi G, Weppler D, Nishida S, Moon J, Madariaga JR, David AI, Gaynor JJ, Thompson J, Hernandez E, Martinez E, Cantwell GP, Augenstein JS, Gyamfi A, Pretto EA, Dowdy L, Tryphonopoulos P, Ruiz P. 100 multivisceral transplants at a single center. Ann Surg. 2005;242:480–90.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Lee RG, Nakamura K, Tsamandas AC, Abu-Elmagd K, Furukawa H, Huston WR, Reyes J, Tabasco-Minguillan JS, Todo S, Demetris AJ. Pathology of human intestinal transplantation. Gastroenterology. 1996;110:1820–34.CrossRefPubMedGoogle Scholar
  6. 6.
    Ruiz P. Updates on acute and chronic rejection in small bowel and multivisceral allografts. Curr Opin Organ Transplant. 2014;19:293–302.PubMedGoogle Scholar
  7. 7.
    Vianna RM, Mangus RS. Present prospects and future perspectives of intestinal and multivisceral transplantation. Curr Opin Clin Nutr Metab Care. 2009;12:281–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Ruiz P, Bagni A, Brown R, Cortina G, Harpaz N, Magid MS, Reyes J. Histological criteria for the identification of acute cellular rejection in human small bowel allografts: results of the pathology workshop at the VIII international small bowel transplant symposium. Transplant Proc. 2004;36:335–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Remotti H, Subramanian S, Martinez M, Kato T, Magid MS. Small-bowel allograft biopsies in the management of small-intestinal and multivisceral transplant recipients. Arch Pathol Lab Med. 2012;136:761–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Florescu DF, Langnas AN, Grant W, Mercer DF, Botha J, Qiu F, Shafer L, Kalil AC. Incidence, risk factors, and outcomes associated with cytomegalovirus disease in small bowel transplant recipients. Pediatr Transplant. 2012;16:294–301.CrossRefPubMedGoogle Scholar
  11. 11.
    de Mezerville MH, Tellier R, Richardson R,S, Hébert D, Doyle J, Allen U. Adenoviral infections in pediatric transplant recipients: a hospital-based study. Pediatr Infect Dis J. 2006;25(9):815–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Florescu DFF, Islam MK, Mercer DF, Grant W, Langnas AN, Freifeld AG, Sudan D, Basappa R, Dimaio D, Kalil AC. Adenovirus infections in pediatric small bowel transplant recipients. Transplantation. 2010;90:198–204.CrossRefPubMedGoogle Scholar
  13. 13.
    Adeyi OA, Randhawa PA, Nalesnik MA, Ochoa ER, Abu-Elmagd M, Demetris AJ, Wu T. Posttransplant adenoviral enteropathy in patients with small bowel transplantation. Arch Pathol Lab Med. 2008;132:703–5.PubMedGoogle Scholar
  14. 14.
    Adeyi OA, Costa G, Abu-Elmagd KM, Wu T. Rotavirus infection in adult small intestine allografts: a clinicopathological study of a cohort of 23 Patients. Am J Transplant. 2010;10:2683–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Ruiz P, Carreno M, Weppler D, Gomez C, Island E, Selvaggi G, Nishida S, Moon J, Levi D, Tekin A, Tryphonopoulos P, Tzakis AG. Immediate antibody-mediated (hyperacute) rejection in small-bowel transplantation and relationship to cross-match status and donor-specific C4d-binding antibodies: case report. Transplant Proc. 2010;42:95–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Dick AAS, Horslen S. Antibody-mediated rejection after intestinal transplantation. Curr Opin Organ Transplant. 2012;17:250–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Abu-Elmagd KM, Wu G, Costa G, Lunz J, Martin L, Koritsy DA, Murase N, Irish W, Zeevi A. Preformed and de novo donor specific antibodies in visceral transplantation: long-term outcome with special reference to the liver. Am J Transplant. 2012;12:3047–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Chang A. Diagnostic pathology. Transplant Pathol. 2014;8:34–37. Amirsys eBook advantage. First Edition.Google Scholar
  19. 19.
    Garcia M, Delacruz V, Ortiz R, Bagni A, Wepler D, Kato T, Tzakis A, Ruiz P. Acute cellular rejection grading scheme for human gastric allografts. Hum Pathol. 2004;35:343–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Andres AM, Santamaría ML, Ramos E, Sarriá J, Molina M, Hernandez F, Encinas JL, Larrauri J, Prieto G, Trovar JA. Graft-vs-host disease after small bowel transplantation in children. J Pediatr Surg. 2010;45:330–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Shin CR, Nathan J, Alonso M, Yazigi N, Kocoshis S, Tiao G, Davies SM. Incidence of acute and chronic graft-versus-host disease and donor T-cell chimerism after small bowel or combined organ transplantation. J Pediatr Surg. 2011;46:1732–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Wu G, Selvaggi G, Nishida S, Moon J, Island E, Ruiz P, Tzakis AG. Graft-versus-host disease after intestinal and multivisceral transplantation. Transplantation. 2011;91:219–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED. Review 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15:825.PubMedGoogle Scholar
  24. 24.
    Siniscalchi A, Cucchetti A, Miklosova A, Lauro A, Zanoni A, Spedicato S, Berardi E, Aurini L, Pinna AD, Faenza S. Post-reperfusion syndrome during isolated intestinal transplantation: outcome and predictors. Clin Transplant. 2012;26:454–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Lenaerts K, Ceulemans LJ, Hundscheid IHR, Grootjans J, Dejong CHC, Olde Damik SWM. New insight in intestinal ischemia-reperfusion injury: implications for intestinal transplantation. Curr Opin Organ Transplant. 2013;18:298–303.CrossRefPubMedGoogle Scholar
  26. 26.
    Valuckaite V, Seal J, Zaborina O, Tretiakova M, Testa G, Alverdy JC. High molecular weight polyethylene glycol (PEG-15-29) maintains mucosal microbial barrier function during intestinal graft preservation. J Surg Res. 2013;183:869–75.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Tsoulfas G, Agorastou P. Ischemia reperfusion injury and the immune system. J Surg Res. 2014;186:114–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Verghese PS, Schmeling DO, Knight JA, Matas AJ, Balfour HH. The impact of donor viral replication at transplant on recipient infections posttransplant: a prospective study. Transplantation. 2014;00:00Y00.Google Scholar
  29. 29.
    Green M, Michaels MG. Epstein–Barr virus infection and posttransplant lymphoproliferative disorder. Am J Transplant. 2013;13:41–54.CrossRefPubMedGoogle Scholar
  30. 30.
    Schaefer N, Tahara K, Websky MV, Koscielny A, Pantelis D, Kalff JC, Abu-Elmagd K, Hirner A, Turler A. Acute rejection and the muscularis propria after intestinal transplantation: the alloresponse, inflammation, and smooth muscle function. Transplantation. 2008;85:1465–75.CrossRefPubMedGoogle Scholar
  31. 31.
    Deyrup AT, Lee VK, Hill CE, Cheuk W, Toh HC, Kesavan S, Ein’en Chan E, Weiss SW. Epstein-Barr virus-associated smooth muscle tumors are distinctive mesenchymal tumors reflecting multiple infection events. A clinicopathologic and molecular analysis of 29 tumors from 19 patients. Am J Surg Pathol. 2006;30:75–82.CrossRefPubMedGoogle Scholar
  32. 32.
    Eisengart LJ, Chou PM, Iyer K, Cohran V, Rajaram V. Rotavirus infection in small bowel transplant: a histologic comparison with acute cellular rejection. Pediatr Dev Pathol. 2009;2:85–8.CrossRefGoogle Scholar
  33. 33.
    Primeggia J, Matsumoto CS, Fishbein TM, Karacki PS, Fredette TM, Timpone JG. Infection among adult small bowel and multivisceral recipients in the 30-day postoperative period. Transpl Infect Dis. 2013;15:441–8.PubMedGoogle Scholar
  34. 34.
    Florescu DF, Qiu F, Mercer DF, Langnas AN, Shafer LR, Kalil AC. Risk factors for systemic Candida infections in pediatric small bowel transplant recipients. Pediatr Infect Dis. 2012;31:120–3.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Antonia D’Errico
    • 1
    Email author
  • Francesco Vasuri
    • 1
  • Alberto Bagni
    • 1
  1. 1.“F. Addarii” Institute of Oncology and Trasplant PathologyS. Orsola Malpighi Hospital, Bologna UniversityBolognaItaly

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