Department of Pediatric Gastroenterology, Hepatology and Nutrition, Koc University School of Medicine, Istanbul, Turkey.
Department of Pathology, Kent Hospital, Izmir, Turkey.
Am J Gastroenterol. 2021 Jan 1;116(1):188-197. doi: 10.14309/ajg.0000000000000934.
To describe the clinical and laboratory profile, natural course, treatment outcome, and risk factors of posttransplant esophageal and nonesophageal eosinophilic gastrointestinal disorders (EGIDs).
All children (aged <18 years) who underwent liver transplantation, between 2011 and 2019, in a single transplant center with a follow-up period of 1 year or more posttransplant and with a history of posttransplant endoscopic evaluation were included in this study.
During the study period, 89 children met the inclusion criteria. Patients were followed for a median of 8.0 years. A total of 39 (44%) patients were diagnosed with EGID after transplantation. Of these, 29 (33%) had eosinophilic esophagitis (EoE), and 10 (11%) had eosinophilic gastritis, gastroenteritis or enterocolitis. In comparison with the non-EGID group, patients with EGID were younger at transplant (P ≤ 0.0001), transplanted more frequently due to biliary atresia (P ≤ 0.0001), and had higher rates of pretransplant allergy (P = 0.019). In the posttransplant period, they had higher rates of mammalian Target of Rapamycin inhibitor use (P = 0.006), Epstein-Barr virus viremia (P = 0.03), post-transplant lymphoproliferative disease (P = 0.005), and allergen sensitization (P ≤ 0.0001). In regression analysis, young age at transplant, age at diagnosis, pretransplant atopic dermatitis, and post-transplant lymphoproliferative disease were associated with an increased risk of EGID or EoE. Laboratory abnormalities such as anemia (P = 0.007), thrombocytosis (P = 0.012), and hypoalbuminemia (P = 0.031) were more commonly observed in the eosinophilic gastritis, gastroenteritis or enterocolitis group than in the EoE group. Following treatment, most patients had symptomatic resolution at 3 months and histologic resolution at 6 months postdiagnosis. Among the patients who had 5 years of follow-up, none recurred.
EGID is a common posttransplant diagnosis, which seems to affect patients who are transplanted earlier and who have pretransplant atopy. Posttransplant EGID is responsive to treatment, but as histologic remission occurs after symptomatic resolution, the decision to perform control endoscopy should be delayed.
描述肝移植后食管和非食管嗜酸性胃肠疾病（EGID）的临床和实验室特征、自然病程、治疗结果和危险因素。
本研究纳入了 2011 年至 2019 年期间在一家单中心接受肝移植、移植后随访 1 年以上的所有年龄<18 岁的儿童，并对其进行了内镜评估。
在研究期间，89 名儿童符合纳入标准。患者中位随访 8.0 年。共有 39 名（44%）患者在移植后被诊断为 EGID。其中，29 名（33%）患有嗜酸性食管炎（EoE），10 名（11%）患有嗜酸性胃炎、胃肠炎或结肠炎。与非 EGID 组相比，EGID 组患者在移植时年龄更小（P≤0.0001），因胆道闭锁而更频繁地接受移植（P≤0.0001），且术前过敏发生率更高（P=0.019）。在移植后期间，他们使用哺乳动物雷帕霉素靶蛋白抑制剂的比率更高（P=0.006），EB 病毒病毒血症的发生率更高（P=0.03），移植后淋巴增生性疾病的发生率更高（P=0.005），过敏原致敏的发生率更高（P≤0.0001）。在回归分析中，移植时年龄较小、诊断时年龄、术前特应性皮炎和移植后淋巴增生性疾病与 EGID 或 EoE 的风险增加相关。嗜酸性胃炎、胃肠炎或结肠炎组更常见的实验室异常包括贫血（P=0.007）、血小板增多症（P=0.012）和低白蛋白血症（P=0.031）。与 EoE 组相比。诊断后 3 个月大多数患者症状缓解，6 个月时组织学缓解。在随访 5 年的患者中，均未复发。
EGID 是一种常见的移植后诊断，似乎影响了更早接受移植且术前存在特应性的患者。移植后 EGID 对治疗有反应，但由于在症状缓解后才出现组织学缓解，因此应延迟进行控制内镜检查的决策。
