Mucosal vascular alterations in isolated small-bowel allografts: Relationship to humoral sensitization

Phillip Ruiz, Monica Garcia, Peter Pappas, Thierry Berney, Violet Esquenazi, Tomoaki Kato, Naveen Mittal, Deborah Weppler, David Levi, Seigo Nishida, Jose Nery, Joshua Miller, Andreas Tzakis

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalAmerican Journal of Transplantation
Issue number1
StatePublished - Jan 2003
Externally publishedYes


  • Small bowel transplantation
  • Vascular rejection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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