2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.11 - Assessment and evolution of immediate post-implant histological changes and correlation with ischemia time in 13 intestinal grafts

Presenter: Jorge, Calvo, , Spain
Authors: Jorge Calvo¹, Patricia LÃ³pez-GarcÃa², Carlos Jimenez¹, Guadalupe LÃ³pez-Alonso², Alejandro Manrique¹, Francisco Colina², Carmelo Loinaz¹, Carolina Ibarrola², Felix Cambra¹, Manolo Abradelo¹, Alvaro GarcÃa-Sesma¹, Enrique Moreno¹

Assessment and evolution of immediate post-implant histological changes and correlation with ischemia time in 13 intestinal grafts

Jorge Calvo¹, Patricia LÃ³pez-GarcÃa², Carlos Jimenez¹, Guadalupe LÃ³pez-Alonso², Alejandro Manrique¹, Francisco Colina², Carmelo Loinaz¹, Carolina Ibarrola², Felix Cambra¹, Manolo Abradelo¹, Alvaro GarcÃa-Sesma¹, Enrique Moreno¹

¹Surgery, University Hospital 12 de Octubre, Madrid, Spain; ²Pathology, University Hospital 12 de Octubre, Madrid, Spain

Introduction: It is necessary to know the lesions produced in the graft mucosa due to harvesting, storage and implantation to assess the subsequent protocolized biopsies.

Aim: The aim is to identify and graduatethe graft mucosal lesions immediately after implantation

Methods: Congestion, hemorrhage, microthrombi, neutrophilic infiltrates, shortening of villi, epithelial detachment, erosion and crypt loss were separately evaluated by two pathologists in paraffin embedded biopsies of the mucosa of 13 grafts on day 1 after implantation. Each change wasassessedas normal, mild, moderate or severe injury and by splinteringthesummationof pointsa global scorewas designed. Cold ischemia time was registered. Correlation was evaluated by Pearson´s coefficient. The same changes were assessed in 19 enteroscopic biopsies from day 2nd to 6th(3.6±1.1) to know their evolution.

Results: Congestion was found in 7 biopsies, microthrombi in 2, hemorrhage in 4, neutrophils in 6, villous atrophy in 8, epithelial detachment in 9, erosions in 2 and/or crypt loss in 2. Global preservation score was grade 3 in 2 cases, grade 2 in 5, grade 1 in 2 and grade 0 in 4. There was positive correlation (r=0.915) in the evaluation between pathologists (p<0.01): Total agreement in 9 biopsies and partial agreement (only 1 point disagreement) in 4. Mean cold ischemia time was 327±101 min. (135-480). There was positive correlation (r=0.694) between preservation score and cold ischemia time (p<0.01). Two cases with a positive crossmatch had histologically grade 2 preservation score. In the follow-up biopsies histological injury decreased of at least one grade in every case.Additionallycariorrexiswas observedin 3 grafts and very occasional apoptosis in 2 others.

Conclusions: 1.- The maximumdegree of preservation injury was expressed as intense congestion and hemorrhageassociated to epithelial detachment and villous atrophy. Occasionally erosions or capillary microthrombi were seen. 2.- Thisscoreachievesgood reproducibility.3.- There was positive correlation between cold ischemia time and preservation injury score. 4.- Preservationinjuriesdecrease notably or disappeared in subsequent first week biopsies. 4.- Two positive crossmatch cases did not show nor specific neither severe injury.

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