immunology allergic disorders
Small Bowel Transplantation
Complications of Small Bowel Transplantation
(See also Posttransplantation Complications .) Weekly endoscopy is initially indicated to check for Rejection . About 30 to 50% of recipients have one or more bouts of rejection within the first year after transplantation. Routine endoscopic surveillance is continued indefinitely. Symptoms and signs of rejection include diarrhea, fever, and abdominal cramping. Endoscopic findings include mucosal erythema, friability, ulceration, and exfoliation; changes are distributed unevenly, may be difficult to detect, and can be differentiated from cytomegalovirus enteritis by viral inclusion bodies. Biopsy findings include blunted villi and inflammatory infiltrates in the lamina propria (see table Manifestations of Small-Bowel Transplant Rejection by Category ). Treatment of acute rejection is high-dose corticosteroids,antithymocyte globulin, or both. Surgical complications affect 50% of patients and include anastomotic leaks, biliary leaks and strictures, hepatic artery thrombosis, and chylous ascites. Nonsurgical complications include the following: Graft ischemia Graft-vs-host disease caused by transplantation of gut-associated lymphoid tissue Later development of lymphoproliferative disease Increased risk of infection 