Routine surveillance endoscopy and biopsy after isolated intestinal transplantation-Revisiting the gold standard

Clinical Transplantation
Jang I MoonKishore R Iyer

Abstract

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 surveil...Continue Reading

References

Apr 30, 2003·Transplantation·Tong WuA Jake Demetris
Mar 16, 2007·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·G SelvaggiA G Tzakis
Apr 5, 2011·Transplantation·David F MercerDebra L Sudan
Jul 21, 2012·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·T HibiA G Tzakis
Sep 8, 2012·Transplantation·Stephen J O'KeefeKareem Abu-Elmagd
May 29, 2015·Journal of Pediatric Gastroenterology and Nutrition·Joanna YehRobert S Venick
Mar 3, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Jason S HawksworthCal S Matsumoto

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Citations

May 21, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Jang I MoonKishore R Iyer
Oct 13, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·James F CrismaleThomas D Schiano

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