Search

Background: Recombinant human growth hormone (rhGH) is widely used to treat growth retardation in children. We aimed to examine the effect of rhGH therapy on growth and its impact on allograft function in children with growth retardation after intestinal transplant (IT). Methods: We retrospectively included children younger than 19 years who had received an IT with or without the liver, were diagnosed with growth retardation, and have received rhGH between January 2010 and January 2021. Changes in the patient's anthropometric parameters between baseline and various time points were compared using the paired t‐test or Wilcoxon signed‐rank test, as appropriate. Results: Seven patients (all males and prepubertal) received rhGH for the median duration of 2.3 years. The median age at rhGH start was 9.5 years. The median growth velocity z‐score improved from −0.95 before treatment to 2.3 (p =.04) and 1.9 (p =.06) after 1 and 2 years of treatment, respectively. The median height‐for‐age z‐score significantly improved from −3.4 at rhGH start to −1.3 (p =.005) at rhGH stop and remained above baseline at the last visit (−2.4, p =.002). The change in the first‐year growth velocity was negatively correlated with the change in the second‐year growth velocity (r = −.90, p =.04). No serious adverse effects or worsening allograft function were observed. Conclusions: Severely growth retarded children after IT could benefit from rhGH treatment. A larger, longitudinal study would be warranted to monitor the long‐term effect and safety of rhGH and examine predictors of growth response to rhGH therapy in these pediatric IT recipients. [ABSTRACT FROM AUTHOR]

In this study, we sought to determine the incidence of post-transplant complications including acute cellular rejection ( ACR), infection, and post-transplant lymphoproliferative disease ( PTLD) in mucosal allograft biopsies in patients with small bowel transplant at our institution. We retrospectively reviewed pathology reports from 5675 small bowel allograft biopsies from 99 patients and analyzed the following: indications for biopsy, frequency and grade of ACR, the presence of infectious agents, results of workup for potential PTLD, results of C4d immunohistochemistry ( IHC), features of chronic mucosal injury, and findings in concurrent native bowel biopsies. Findings from 42 allograft resection specimens were also correlated with prior biopsy findings. Indeterminate, mild, moderate, and severe ACR were seen in 276 (4.9%), 409 (7.2%), 100 (1.8%), and 207 (3.6%) of biopsies, respectively. Although ACR may show histologic overlap with mycophenolate mofetil toxicity, we found the analysis of concurrent native bowel biopsies to be helpful in this distinction. Adenovirus was the most common infectious agent seen (11%), and we routinely performed adenovirus IHC on biopsies. Eighteen patients (18%) developed PTLD, 83% of which were EBV associated, but only 28% of PTLD cases were diagnosed on mucosal allograft biopsies. C4d IHC did not correlate with the presence of donor-specific antibodies in limited cases. [ABSTRACT FROM AUTHOR]

Small bowel transplantation from SARS-CoV-2 respiratory PCR positive donors: Is it safe? Hence, as organ transplantation continues globally, it is crucial to minimize the risk of donor derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in SOT recipients. Keywords: COVID-19; donor; small bowel transplant EN COVID-19 donor small bowel transplant 1 2 2 12/27/21 20211201 NES 211201 Dear Editor, We read with great interest the recently published article titled "The pandemic provides a pathway: What we know and what we need to know about COVID positive donors" by Eichenberger et al.1 The coronavirus disease of 2019 (COVID-19) pandemic has significantly affected the solid organ transplant (SOT) community. [Extracted from the article]

Pasternak BA, Collins MH, Tiao GM, Rudolph JA, Alonso MH, Ryckman FC, Kocoshis SA. Anatomic and histologic variability of epithelial apoptosis in small bowel transplants. Pediatr Transplantation 2010: 14: 71–76. © 2009 Wiley Periodicals, Inc. Surveillance ileoscopies are performed regularly immediately post-transplantation to prevent allograft rejection. We investigated whether variability in apoptosis exists between proximal and distal intestinal limbs of double-barreled ileostomies, and if detection varies according to number of biopsies taken and sections prepared for evaluation. We retrospectively analyzed endoscopy/pathology reports of patients who underwent simultaneous proximal and distal ileoscopies during surveillance. We re-reviewed three sections of selected biopsies for the presence of apoptotic bodies and viral inclusions. Seven patients underwent 26 endoscopies in which both distal and proximal limbs were investigated simultaneously. Apoptosis was identified in each limb simultaneously in 21/26 cases (81%). Of the discrepant results, 3/5 (60%) revealed apoptosis in the proximal limb with normal distal limb and 2/5 (40%) had apoptotic bodies identified in the distal limb and normal proximal biopsies. Re-reviewing discrepant biopsies, two patients had at least one piece of mucosa without apoptosis and apoptotic bodies were seen in only 47% of sections. Histologic variability exists between proximal and distal limbs of double-barreled ileostomies and detection of apoptosis increases with number of pieces obtained and sections examined. Investigating both limbs with adequate sample size and rigorous processing may have clinical implications. [ABSTRACT FROM AUTHOR]

F. Gruz, C. Fuxman, A. Errea, M. Tokumoto, A. Fernandez, J. Velasquez, C. Nagel, A. Ruf, E. Mauriño, F. Nachman, M. Rumbo, G. Gondolesi. Isospora belli infection after isolated intestinal transplant. Transpl Infect Dis 2010: 12: 69–72. All rights reserved Isospora belli is a protozoan that only affects humans, after ingestion of Isospora's oocysts. Immunocompetent patients usually do not develop the infection. Immunocompromised hosts may have profuse diarrhea with other gastrointestinal symptoms. Treatment is based on trimethoprim-sulfamethoxazole. In 2006 we performed an isolated intestinal transplantation in a patient with ultra-short bowel syndrome. Neither rejection nor clinical problems occurred after transplant, but signs of intestinal inflammation were seen in every protocol biopsy starting at the first month post transplant. Almost 3 months after the procedure, the patient was re-admitted with diarrhea. I. belli infection was diagnosed by detection of the oocysts in stool samples. Antibiotic treatment with trimethoprim–sulfamethoxazole was initiated with excellent outcome and without relapses. To the best of our knowledge, this is the first case of isosporosis in a small bowel recipient. [ABSTRACT FROM AUTHOR]

Abstract: Herpes simplex virus (HSV) has been a rare cause of gastrointestinal (GI) infection, especially in immunocompromised patients. A variety of GI sites may be involved; however, only three reported cases of HSV colitis have been documented in the literature. To our knowledge, this is the first report of HSV colitis in a small bowel transplant recipient. [ABSTRACT FROM AUTHOR]

Clinical small bowel transplantation (SBTx) has been associated with a high rate of infectious complications. Laparotomy, preservation injury, abnormal motility, lymphatic disruption, aberrant systemic venous drainage, rejection and antibiotic therapy could all be implicated in the etiology of these complications. In addition to the underlying disease, total parental nutrition could determine infections and liver impairment. Recently, standardized techniques for segmental living related SBTx (LR-SBTx) have been developed. This technique allows reduction of some of these factors, thus resulting in a reduced incidence of infections. We report the infectious complications observed in 3 patients with short bowel syndrome treated with LR-SBTx at our institution. A segment of 180–200 cm of ileum was transplanted with a neglectably short cold ischemia time (CIT). The donor bowel was decontaminated. Oral tacrolimus, prednisone and IV induction with ATG were used for immunosuppression. Blood, stool, urine, sputum and peritoneal fluids were collected and cultured as a routine surveillance. All recipients are alive with a current follow-up time up to 21 months. No bacterial infections were observed during the post-transplant period. One patient developed cytomegalovirus (CMV) enteritis 4 months after LR-SBTx and was treated successfully with IV ganciclovir. In our limited experience, LR-SBTx is associated with a low infection rate. This could be due to optimal graft decontamination, short CIT and to the reduced incidence of rejection and lower immunosuppression used in this immunologically well-matched combination. [ABSTRACT FROM AUTHOR]