TY - JOUR
T1 - Mucosal vascular alterations in isolated small-bowel allografts
T2 - Relationship to humoral sensitization
AU - Ruiz, Phillip
AU - Garcia, Monica
AU - Pappas, Peter
AU - Berney, Thierry
AU - Esquenazi, Violet
AU - Kato, Tomoaki
AU - Mittal, Naveen
AU - Weppler, Deborah
AU - Levi, David
AU - Nishida, Seigo
AU - Nery, Jose
AU - Miller, Joshua
AU - Tzakis, Andreas
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2003/1
Y1 - 2003/1
N2 - Acute vascular rejection (AVR) in human small-bowel transplantation is an inadequately characterized entity whose frequency and severity is not well understood. As compared to severe AVR, changes identifying early, mild or evolving AVR are not known. We created a scoring system to evaluate subtle mucosal vascular changes and examined 188 biopsies from 21 patients obtained in the first 3 months post transplant. A majority of patients had a transient rise in vascular injury, often within 30days of transplant. Small-vessel congestion and erythrocyte extravasation were the most common alterations. The vascular injury score was not related to acute cellular rejection, HLA type or HLA antigen disparities. However, the patients with the vascular changes had significantly higher peak panel reactive antibodies (PRA) and a higher incidence of positive T-cell and B-cell crossmatch. Finally, graft survival was significantly lower in the patients demonstrating the early vascular lesions. These data suggest that the vascular injury is partially associated with humoral presensitization of the recipient and may be a form of acute vascular rejection. Since these vascular changes are frequent, we advocate early post-transplant monitoring to identify and manage potentially high-risk patients.
AB - Acute vascular rejection (AVR) in human small-bowel transplantation is an inadequately characterized entity whose frequency and severity is not well understood. As compared to severe AVR, changes identifying early, mild or evolving AVR are not known. We created a scoring system to evaluate subtle mucosal vascular changes and examined 188 biopsies from 21 patients obtained in the first 3 months post transplant. A majority of patients had a transient rise in vascular injury, often within 30days of transplant. Small-vessel congestion and erythrocyte extravasation were the most common alterations. The vascular injury score was not related to acute cellular rejection, HLA type or HLA antigen disparities. However, the patients with the vascular changes had significantly higher peak panel reactive antibodies (PRA) and a higher incidence of positive T-cell and B-cell crossmatch. Finally, graft survival was significantly lower in the patients demonstrating the early vascular lesions. These data suggest that the vascular injury is partially associated with humoral presensitization of the recipient and may be a form of acute vascular rejection. Since these vascular changes are frequent, we advocate early post-transplant monitoring to identify and manage potentially high-risk patients.
KW - Small bowel transplantation
KW - Vascular rejection
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U2 - 10.1034/j.1600-6143.2003.30108.x
DO - 10.1034/j.1600-6143.2003.30108.x
M3 - Article
C2 - 12492709
AN - SCOPUS:0037221807
VL - 3
SP - 43
EP - 49
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 1
ER -