P4.19: Incidence and Severity of Acute Cellular Rejection in the Recipients of Small Bowel Transplantation in Taiwan

Introduction: Intestinal transplantation is considered as the ultimate life-saving treatment for the patients with irreversible end-stage intestinal failure. The 5-year survival rate is currently around 60% according to international results. Post-transplantation episodes of acute cellular rejection, systemic infection, and, in later stages, chronic rejection are the major prognostic factors for the survival of recipients and grafts. In this research we analyzed the histological findings and the outcomes among the 22 cases of isolated intestinal transplantation in our institute in Taiwan. Methods: Patients received intestinal transplantation were under periodical graft surveillance by intestinal biopsy through ileostomy. The biopsy histology reports from the 22 cases of intestinal transplantation were retrospectively reviewed and analyzed by IBM SPSS software. The use of data was approved and under the supervision of Institution Review Board (IRB) of Far Eastern Memorial Hospital, New Taipei City, Taiwan. Results: The 1, 3, and 5-year patient survival rates of intestinal transplant recipients in our institute are 83.7%, 72.2%, and 66.7%, respectively. During year 2007 to 2017, the total amount of biopsies taken from these 22 cases is 904. In these biopsy reports, 734 biopsies (80.9 %) were reported as indeterminate for acute cellular rejection (ACR), 39 biopsies (4.3%) as mild ACR, 18 biopsies (2.0%) as moderate ACR, and 103 biopsies (11.4%) as severe ACR (Figure 1). Among the 22 cases, 15 cases (68.2%) had been diagnosed as ACR, in which 6 were reported as mild rejection, whereas the other 9 as moderate to severe rejection. Furthermore, 10 cases within these 15 ACR cases (66.7%) developed ACR in the first 3 months after transplantation. Conclusion: In our series of small bowel transplantation, the incidence of acute cellular rejection was 68.2%, which is comparable with other American and European centers. Scheduled graft surveillance with histological inspection greatly helped the monitoring of rejection episodes and the subsequent timely treatments for the patients.