Wade Cian, Allan Philip, Collantes Elena, Reddy Srikanth R, Friend Peter J, Vrakas Georgios
University of Oxford Medical Sciences Division, Medical Sciences Office, JR Hospital, Headley Way, Oxford OX3 9DU, UK.
Oxford University Hospitals NHS Foundation Trust, Oxford Transplant Centre, Churchill Hospital, Old Road, Oxford OX3 9DU, UK.
Case Rep Transplant. 2017;2017:2498423. doi: 10.1155/2017/2498423. Epub 2017 Aug 6.
Recent advances in the field of intestinal transplantation have been mitigated by the incidence of allograft rejection. In such events, early identification and appropriate timing of antirejection therapy are crucial in retaining graft function. We present the case of a patient who suffered severe postintestinal transplantation allograft enteropathy, primarily characterized by extensive mucosal ulcerations, and was refractory to all conventional therapy. This progressed as chronic rejection; however crucially this was not definitively diagnosed until allograft function had irreversibly diminished. We argue that the difficulties encountered in this case can be attributed to the inability of our current array of investigative studies and diagnostic guidelines to provide adequate clinical guidance. This case illustrates the importance of developing reliable and specific markers for guiding the diagnosis of rejection and the use of antirejection therapeutics in this rapidly evolving field of transplant surgery.
肠道移植领域的最新进展因同种异体移植排斥反应的发生率而受到影响。在这类情况下，早期识别和抗排斥治疗的恰当时机对于维持移植物功能至关重要。我们报告一例肠道移植术后发生严重同种异体移植肠病的患者，其主要特征为广泛的黏膜溃疡，对所有传统治疗均无效。病情进展为慢性排斥反应；然而关键的是，直到移植物功能不可逆转地减退时才得以明确诊断。我们认为，该病例中遇到的困难可归因于我们目前一系列的调查研究和诊断指南无法提供充分的临床指导。该病例说明了在这个快速发展的移植外科领域中，开发可靠且特异的标志物以指导排斥反应的诊断及抗排斥治疗应用的重要性。
