2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.54 - Histologic concordance of proximal and distal stoma biopsies from transplanted intestine loop ileostomy

Presenter: Cal , Matsumoto, , United States
Authors: Cal Matsumoto¹, Stuart Kaufman¹, Victoria Stuss¹, Kirti Shetty¹, Jaqueline Laurin¹, Rohit Satoskar¹, Nada Yazigi¹, Khalid Khan¹, Eddie Island¹, Rafaelle Girlanda¹, Chirag Desai¹, Bashkar Kalakury¹, Thomas Fishbein¹

Histologic concordance of proximal and distal stoma biopsies from transplanted intestine loop ileostomy

Cal Matsumoto¹, Stuart Kaufman¹, Victoria Stuss¹, Kirti Shetty¹, Jaqueline Laurin¹, Rohit Satoskar¹, Nada Yazigi¹, Khalid Khan¹, Eddie Island¹, Rafaelle Girlanda¹, Chirag Desai¹, Bashkar Kalakury¹, Thomas Fishbein¹

¹Georgetown Transplant Institute, Washington DC, DC, United States

Introduction: Intestinal graft biopsy, performed on a frequent protocol basis, is the only accepted means of determining allograft rejection in human intestinal transplantation. In cases where a temporary loop ileostomy is constructed, intestinal graft biopsies are mandatorily obtained from the proximal limb and, per the discretion of the endoscopist, from distal limbs of the loop. The immunologic response of the transplanted intestine distal limb with faecal diversion is unknown. We characterize the concordance of graft biopsies in the proximal and distal limb of a transplant intestine allograft in cases where a simultaneous proximal and distal limb graft biopsy was obtained.

Methods: A retrospective review of all simultaneous proximal and distal loop ileostomy biopsies performed at our center.

Results:135 intestinal transplant recipients were analyzed from the period from November 2003 to June 2011. 3,260 total biopsy events were recorded, for a mean number of biopsy episodes of 24.2 per recipient. 87/135 (64 %) recipients had a loop ileostomy performed with their intestine transplant with a total of 2292 biopsy events. 984/2292 ( 43 %) biopsy events had both a proximal and distal loop biopsy taken. Six recipients had 12 discrepancies between the simultaneous reading of the proximal and distal biopsy. The proximal and distal biopsy concordance was 98.8%.

12 discrepancies in the 6 patients are described:

4 patients had 8 discrepancies between the proximal and distal biopsies noted in follow-up biopsies events from the index rejection biopsy. The results of the discrepancies show perhaps a lag time in recovery of the distal limb from the proximal limb in recovery from rejection.

1 patient, in an index biopsy for rejection, the distal limb revealed no pathology, and the proximal limb revealed Grade 1 ACR. This episode resolved quickly with steroid bolus and subsequent proximal and distal biopsies were concordant.

1 another patient, in an index biopsy for rejection, the distal limb revealed mild nonspecific LP inflammation, and the proximal limb was normal. This prompted closer surveillance, and subsequent biopsies also revealed 2 discordant biopsy results, however, in those episodes the proximal limb revealed Grade 1 ACR and the distal limb revealed no pathology.

Conclusion: The histologic concordance for proximal and distal loop stoma biopsies in this series was 98.8%. In the few discordant episodes, there was a lag time in recovery from rejection in the distal limb, perhaps signifying a role of effluent stimulus in the recovery from acute cellular rejection.

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