2013 - ISBTS 2013 Symposium

This page contains exclusive content for the member of the following sections: TTS, IXA, ITA. Log in to view.

Posters and Exhibition

15.16 - Proposal of a grading scheme for the diagnosis of acute antibody-mediated rejection in small bowel transplantation

Presenter: Olivier, Corcos, , France
Authors: Dominique Cazals-Hatem1, Caroline Suberbielle2, Francisca Joly3, Alexandre Hertig4, Olivier Goulet5, Yves Panis6, Florence Lacaille5, Yoram Bouhnik3, Olivier Corcos3

Proposal of a grading scheme for the diagnosis of acute antibody-mediated rejection in small bowel transplantation

Dominique Cazals-Hatem1, Caroline Suberbielle2, Francisca Joly3, Alexandre Hertig4, Olivier Goulet5, Yves Panis6, Florence Lacaille5, Yoram Bouhnik3, Olivier Corcos3

1Department of Pathology, Beaujon Hospital, Clichy, France; 2jean Dausset Laboratory, Saint-Louis Hospital, Paris, France; 3Gastroenterology and Intestinal Failure, Beaujon hospital, Clichy, France; 4Department of Nephrology and Renal transplantation, Tenon Hospital, Paris, France; 5Pediatric Hepatogastroenterology-Nutrition, Necker-Enfants Malades Hospital, Paris, France; 6Department of Colorectal Surgery and Intestinal Transplantation, Beaujon Hospital, Clichy, France

 

Introduction: The importance of antibody-mediated rejection (AMR) in SBT failures is a major issue. No consensus does exist concerning the diagnosis criteria of AMR in SBT. According to 1) published data, 2) updated Banff criteria, 3) our experience in SBT, we aimed to elaborate a simple and reproducible grading scheme for AMR in SBT.
Methods: Positive diagnosis of AMR was based on the association of 1) clinical graft dysfunction (increased of 20% stoma outpout or diarrhea, protein-losing enteropathy and/or endoscopic mucosal injury), 2) increase or apparition of DSA and 3) vascular histological lesions. After discarding infections, vascular and epithelial changes observed on endoscopies/biopsies were retrospectively and prospectively analyzed to define and grade the histological patterns of AMR in SBT. In cases with both vascular and cellular rejection lesions, a frank C4d staining was considered for humoral rejection component. In litigious cases with steroids resistant rejection, DSA>1000 but without visible vascular lesions, rejection was classified as “undefined for AMR”.
Results:From 07/2008 to 12/2012 we followed 13 SBT patients (adult n=6, children n=7).  6 patients presented at least one episode of presumed AMR (46%). At histology AMR was characterized by the association of 1) capillaritis defined by several inflammatory cells beneath the endothelium and in the vascular lumen 2) capillary congestion and/or blood extravasation 3) Fibrin and/or hyaline thrombus (table 1). AMR was graded accordingto additional endoscopic and epithelial changes as mentioned in table 1. Grade 3 AMR were often associated with acute cellular rejection lesions.
Conclusion: We propose to evaluate prospectively this grading scheme for AMR diagnosis in SBT as a first step for larger consensus criteria.

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada

Info

Privacy Policy
Terms of Use
Copyright Notice