Hussan Elsadig, Kroemer Alexander, Elsabbagh Ahmed M, Khan Khalid M, Yazigi Nada A, Ekong Udeme D, Subramanian Sukanya, Ghobrial Shahira S, Guerra Juan-Francisco, Fishbein Thomas M, Matsumoto Cal S, Kaufman Stuart S
MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
Transplant Direct. 2023 Oct 25;9(11):e1529. doi: 10.1097/TXD.0000000000001529. eCollection 2023 Nov.
Idiopathic ileal ulceration after intestinal transplantation (ITx) has been discussed infrequently and has an uncertain natural history and relation to graft rejection. Herein, we review our experience with this pathology.
We retrospectively reviewed 225 ITx in 217 patients with minimum 1 y graft survival. Routine graft endoscopy was conducted up to twice weekly within the first 90 d after ITx, gradually decreasing to once yearly. Risks for ulceration over time were evaluated using Cox regression.
Of 93 (41%) patients with ulcers, 50 were found within 90 d after ITx mostly via ileoscopy; delayed healing after biopsy appeared causal in the majority. Of the remaining 43 patients with ulcers found >90 d after ITx, 36 were after ileostomy closure. Multivariable modeling demonstrated within 90-d ulcer associations with increasing patient age (hazard ratio [HR], 1.027; < 0.001) and loop ileostomy (versus Santulli ileostomy; HR, 0.271; < 0.001). For ulcers appearing after ileostomy closure, their sole association was with absence of graft colon (HR, 7.232; < 0.001). For ulcers requiring extended anti-microbial and anti-inflammatory therapy, associations included de novo donor-specific antibodies (HR, 3.222; < 0.007) and nucleotide oligomerization domain mutations (HR, 2.772; < 0.016). Whole-cohort post-ITx ulceration was not associated with either graft rejection ( = 0.161) or graft failure ( = 0.410).
Idiopathic ulceration after ITx is relatively common but has little independent influence on outcome; risks include ileostomy construction, colon-free ITx, immunologic mutation, and donor sensitization.
肠道移植（ITx）后特发性回肠溃疡鲜有讨论，其自然病程以及与移植排斥的关系尚不确定。在此，我们回顾我们在这种病理情况方面的经验。
我们回顾性分析了217例患者的225例ITx，这些患者的移植物存活时间至少为1年。在ITx后的前90天内，每周进行常规移植物内镜检查最多两次，之后逐渐减少至每年一次。使用Cox回归评估随时间发生溃疡的风险。
在93例（41%）有溃疡的患者中，50例在ITx后90天内被发现，大多通过回肠镜检查；活检后愈合延迟在大多数情况下似乎是病因。在其余43例在ITx后90天以上发现溃疡的患者中，36例是在回肠造口关闭后。多变量模型显示，90天内的溃疡与患者年龄增加（风险比[HR]，1.027；P<0.001）和袢式回肠造口术（与Santulli回肠造口术相比；HR，0.271；P<0.001）有关。对于回肠造口关闭后出现的溃疡，其唯一关联因素是没有移植结肠（HR，7.232；P<0.001）。对于需要延长抗菌和抗炎治疗的溃疡，相关因素包括新出现的供体特异性抗体（HR，3.222；P<0.007）和核苷酸寡聚化结构域突变（HR，2.772；P<0.016）。整个队列在ITx后的溃疡与移植排斥（P=0.161）或移植失败（P=0.410）均无关联。
ITx后的特发性溃疡相对常见，但对结局几乎没有独立影响；风险因素包括回肠造口术构建、无结肠ITx、免疫突变和供体致敏。
