Related Experiment Video
Updated: Jul 13, 2026
A Rat Graft Rejection Model of Intestinal Transplantation with Exteriorized Ileostomy for Longitudinal Prognosis Assessment
Published on: June 10, 2025
The development of eosinophilic colitis after liver transplantation in children
Jee Hyun Lee1, Hwa Young Park, Yon Ho Choe
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong Gangnam-Gu, Seoul 135-710, South Korea.
Insights
Eosinophilic gastrointestinal disorders (EGID) affect 37% of pediatric liver transplant recipients, often presenting with gastrointestinal symptoms and peripheral eosinophilia. Early consideration of EGID is crucial for timely diagnosis and effective food restriction treatment.
Area of Science:
- Pediatric Gastroenterology
- Transplant Immunology
- Allergy and Immunology
Background:
- Tacrolimus-based immunosuppression is a known risk factor for eosinophilic gastrointestinal disorders (EGID) in pediatric liver transplant recipients.
- EGID can mimic symptoms of post-transplant lymphoproliferative disorder (PTLD), complicating diagnosis.
Purpose of the Study:
- To determine the incidence, risk factors, and clinical characteristics of EGID in pediatric liver transplant recipients.
- To differentiate EGID from gastrointestinal PTLD in this patient population.
Main Methods:
- Retrospective analysis of 38 pediatric liver transplant recipients.
- Evaluation of rectal mucosal biopsies for gastrointestinal PTLD and eosinophilic colitis.
- Analysis of clinical data including peripheral eosinophilia, EBV infection rates, and food-specific IgE levels.
Main Results:
- 14 patients (37%) were diagnosed with eosinophilic colitis.
- Eosinophilic colitis was associated with higher incidence of peripheral eosinophilia and EBV infection within two months post-transplant.
- Symptoms appeared at an average of three months, with diagnosis at 6.9 months; 57% had elevated food-specific IgE.
Conclusions:
- EGID is a significant concern in pediatric liver transplant recipients on tacrolimus.
- Peripheral eosinophilia and EBV seroconversion in the early post-transplant period warrant consideration for EGID.
- Food restriction demonstrated efficacy in managing EGID symptoms.
Abstract:
Tacrolimus-based immunosuppression in pediatric liver transplant recipients is known to be associated with EGID. Our goal was to determine the incidence, risk factors, and characteristics of EGID in our pediatric liver transplantation program. This study was a retrospective analysis of 38 pediatric liver transplant recipients. Rectal mucosal biopsy was performed to evaluate for gastrointestinal PTLD and eosinophilic colitis. There were 14 patients (37%) who were diagnosed with eosinophilic colitis. The mean age at transplantation was 10.8 +/- 1.8 months. Those with eosinophilic colitis had a higher incidence of peripheral eosinophilia (p = 0.003) during the first two months following transplantation and had a higher EBV infection rate. Symptoms, such as diarrhea, hematochezia, and abdominal pain, became apparent after an average of three months; diagnoses were made at 6.9 +/- 2.0 months after transplantation. There were eight patients (57%) with elevated food-specific IgE levels. With food restriction treatment, the symptoms of patients improved. EGID should be considered when clinical symptoms are present, because symptoms of this disorder are similar to those of gastrointestinal PTLD. It should also be considered when peripheral eosinophila is detected or when EBV seroconversion develops during the first two months following transplantation.
