The recurrence of Crohn's disease in small intestinal allografts can cause serious morbidity, and jeopardize graft survival among transplant recipients with Crohn's.
However, systematic studies to determine the frequency, predictors, and clinical implications of recurrent Crohn's disease have not been reported.
Dr Noam Harpaz and colleagues analyzed the transplant program's experience with small intestinal allografts in Crohn's disease.
The research team conducted a retrospective review of clinical pathological records, and of corresponding pathology slides.
Of 67 patients undergoing 70 transplantations between 1998 and 2004, 3 males and 3 females with a mean age of 48 years had Crohn's disease.
Crohn's disease was complicated by short gut syndrome and total parenteral nutrition failure.
|2 patients had granulomatous enteritis characteristic of Crohn's in multiple biopsies|
The team surveyd 4 survivors endoscopically for a mean of 29 months.
The patients underwent a mean 37 endoscopic examinations with biopsies while on maintenance immunosuppression.
The researchers reported an absence of any endoscopic or clinical manifestations of Crohn's disease throughout this period.
However, 2 patients had granulomatous enteritis characteristic of Crohn's disease in multiple biopsies.
Out of these patients, 1 presented with the characteristics in 8 out of 44 examinations, ranging from 34 days to 20 months postoperatively.
The other patient was identified in 6 out of 32 examinations, ranging from 20 days to 22 months postoperatively.
The team observed no comparable changes in the 57 other patients without Crohn's disease that were followed endoscopically under the same protocol.
Dr Harpaz's team concluded, “Histological recurrence of Crohn's disease may occur in small intestinal allografts despite the absence of endoscopic and clinical disease manifestations.”
“Such recurrences are probably not rare, and may occur as early as 3 weeks after transplantation.”
“These recurrences do not necessarily portend early clinical recurrence or mandate aggressive therapy to prevent allograft loss.”