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2011 - ISBTS 2011 Symposium

Oral Communications 4: Intestinal Immunosuppression / Rejection

6.131 - Late onset acute rejection following intestinal transplantation (ITx) - a single centre experience

Presenter: Andrea, Pietrobattista, Birmingham, UK, United Kingdom
Authors: Andrea Pietrobattista1, Sara Gozzini1, Khalid Sharif1, Paolo Muiesan1, Darius Mirza1, Girish Gupte1

Late onset acute rejection following intestinal transplantation (ITx) - a single centre experience

Andrea Pietrobattista, Sara Gozzini, Khalid Sharif, Paolo Muiesan, Darius Mirza, Girish Gupte

Liver Unit including small bowel trasplantation, Birmingham Children Hospital, Birmingham, United Kingdom

Introduction and aim: Acute  rejection (AR) affects > 60% of ITx  between day 5- 60. Limited data exists about late onset AR (>6 months post-ITx). Aim of our study is to evaluate the incidence of late onset of AR in SBT.

Methods: Retrospective review of ITx 1998-2009 with confirmed histopathological diagnosesof  late onset AR. 57 patients for a total of 63 SBT were included in the study.

 Results: Of the 112 episodes of AR,  59 (52%) presented as late onset. 8 patients (12.6%), experienced the first episodes at least 6 months after the SBT with  2/8 after 24 months ( graft survival 75%).

Table 1:


Liver inclusive graft

Liver not included in graft


No of patients




No of episodes













Single MP, ↑ IS

3 boluses MP, ↑IS, ± ATG/OKT3

ATG/OKT3, Campath

Median age to rejection from post-Tx




Chronic rejection












MP= Methylprenisolone 20 mg /kg to max of 400 mg

IS= Immunosuppression

Discussion: No graft has been removed as part of the treatment for late AR despite the higher incidence of a severe grade (20%) compared with the overall grading of late AR. Levels of IS prior to the episode of rejection reviewed were within the target range.

Conclusion: Late AR is not rare in SBT. Aggressive medical treatment of late onset AR is necessary for essential survival of the patient.

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