Pittman Meredith E, Jessurun Jose, Yantiss Rhonda K
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY.
Am J Surg Pathol. 2017 Dec;41(12):1666-1674. doi: 10.1097/PAS.0000000000000921.
Renal transplant recipients who present with gastrointestinal complaints may have symptoms related to their underlying renal disease or secondary to their immunosuppressive regimen. Immunosuppression increases patients' risk for infection and medication-induced injury, and a subset of transplant patients develop a form of inflammatory bowel disease (IBD) despite being immunosuppressed. In this study, we present the spectrum of changes in colonic biopsy histology that occur in the postrenal transplant population, with emphasis on the clinical and histologic features that may allow distinction between several common disorders. Over a 15-year period, 51 postrenal transplant patients underwent colonoscopy with biopsy. Eleven (22%) patients had infectious colitis, and 10 of these had biopsy proven acute colitis. Another 17 (33%) patients were determined to have a medication-related injury based on resolution of symptoms following drug cessation. The majority (53%) of these colonic biopsies demonstrated crypt epithelial cell apoptosis and/or architectural distortion, although 41% were histologically normal. Four (8%) patients were ultimately diagnosed with a form of IBD after exclusion of other etiologies; biopsies from these patients demonstrated chronic active colitis or enteritis with plasma cell-rich expansion of the lamina propria and basal lymphoplasmacytosis. The increased prevalence of IBD in this patient cohort (4/700) compared with that reported in the overall North American population (1 to 2/700) is in line with prior studies and is likely related to the therapeutic regimen and associated immune dysregulation that occurs in solid-organ transplant recipients. We demonstrate that a combination of clinical, endoscopic, and histologic features are useful to distinguish among causes of gastrointestinal symptoms in this high risk population.
出现胃肠道不适症状的肾移植受者，其症状可能与潜在的肾脏疾病有关，或继发于免疫抑制方案。免疫抑制会增加患者感染和药物性损伤的风险，尽管处于免疫抑制状态，但仍有一部分移植患者会患上某种形式的炎症性肠病（IBD）。在本研究中，我们展示了肾移植后人群结肠活检组织学变化的范围，重点关注可能有助于区分几种常见疾病的临床和组织学特征。在15年的时间里，51例肾移植后患者接受了结肠镜活检。11例（22%）患者患有感染性结肠炎，其中10例经活检证实为急性结肠炎。另外17例（33%）患者根据停药后症状缓解被确定为药物相关损伤。这些结肠活检中的大多数（53%）显示隐窝上皮细胞凋亡和/或结构扭曲，尽管41%在组织学上是正常的。排除其他病因后，4例（8%）患者最终被诊断为某种形式的IBD；这些患者的活检显示为慢性活动性结肠炎或肠炎，固有层有富含浆细胞的扩张和基底淋巴细胞浆细胞增多。与北美总体人群（1至2/700）报告的患病率相比，该患者队列中IBD患病率的增加（4/700）与先前的研究一致，可能与实体器官移植受者的治疗方案及相关的免疫失调有关。我们证明，临床、内镜和组织学特征的组合有助于区分这一高风险人群胃肠道症状的病因。
