Moon Jang I, Schiano Thomas D, Iyer Kishore R
Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Clin Transplant. 2019 Oct;33(10):e13684. doi: 10.1111/ctr.13684. Epub 2019 Aug 30.
The value of endoscopy and biopsy after intestinal transplantation in the absence of clinical concerns has never been investigated. We examined clinical yield of routine surveillance endoscopy and biopsy (control group, n = 28, Jan 2011 to Jun 2014). Most episodes of acute rejection were diagnosed when there were clinical symptoms or signs such as increased stoma output, fever, or bacteremia, but not by routine surveillance endoscopy and biopsy. The new protocol abandoned routine surveillance. Intestinal allografts were examined only when relevant clinical symptoms and/or signs raised concern for graft dysfunction. We compared outcomes between control and study groups (new protocol, n = 25, Jul 2014 to Dec 2016). Incidence of acute rejection (32% vs 32%), graft salvage rate after acute rejection treatment (78% vs 63%), patient survival (75% vs 88% 1 year, 71% vs 83% 3 years after intestinal transplantation), and graft survival (68% vs 80% 1 year, 61% vs 76% 3 years after intestinal transplantation) were similar between control and study groups. Protocol-driven, routine surveillance endoscopy, and biopsy do not appear to confer any survival advantage to patients or grafts. Endoscopy and biopsy "for cause" without routine surveillance seem to be effective and adequate to monitor intestinal allografts.
在没有临床疑虑的情况下，肠道移植后内镜检查和活检的价值从未被研究过。我们检查了常规监测性内镜检查和活检的临床效果（对照组，n = 28，2011年1月至2014年6月）。大多数急性排斥反应发作是在出现临床症状或体征，如造口排出量增加、发热或菌血症时被诊断出来的，而不是通过常规监测性内镜检查和活检。新方案放弃了常规监测。仅在相关临床症状和/或体征引起对移植物功能障碍的担忧时才对肠道移植物进行检查。我们比较了对照组和研究组（新方案，n = 25，2014年7月至2016年12月）之间的结果。对照组和研究组之间急性排斥反应的发生率（32%对32%）、急性排斥反应治疗后的移植物挽救率（78%对63%）、患者生存率（肠道移植后1年为75%对88%，3年为71%对83%）以及移植物生存率（肠道移植后1年为68%对80%，3年为61%对76%）相似。方案驱动的常规监测性内镜检查和活检似乎并未给患者或移植物带来任何生存优势。不进行常规监测的“按需”内镜检查和活检似乎对监测肠道移植物是有效且足够的。
