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Published on: November 6, 2012
Bacterial translocation in adult small bowel transplantation
A Cucchetti1, A Siniscalchi, A Bagni
1Department of Surgery and Transplantation, Pathology Division of "Addarii" Institute, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. aleqko@libero.it
Abstract:
The application of intestinal transplantation is limited by the high rate of infectious complications that can occur; the migration of enteric microorganisms to extraintestinal sites (bacterial translocation) has been suggested to be responsible for this event. We reviewed 95 intestinal biopsies performed on 28 transplanted patients to identify histologic features predictive of isolation of enteric microorganisms in extraintestinal sites within the first month after transplantation. At least 1 isolation of enteric microorganisms in the peritoneal cavity and/or in blood samples was obtained in 13 patients (46.4%); this event led to higher 1-year mortality (38.5% vs. 6.7%; P = .041). Of the 95 biopsies, 38 were followed by positive cultures (40.0%), showing higher degrees of mucosal vascular alterations (Ruiz grade) and ischemia/reperfusion injuries (Park/Chiu grade) compared with the negative cases (P < .05). We also observed an higher prevalence of positive cultures in relation to acute cellular rejection episodes (P = .091). Neither clinical or surgical factors nor immunosuppressive therapy were observed to be significantly related to positive cultures. Histologic alterations of the small bowel allograft are related to isolation of enteric microorganisms in extraintestinal sites. The degree of these histologic features can identify patients at high risk of potentially life-threatening infectious complications and death.
Insights
Histologic changes in intestinal allografts predict bacterial translocation, a complication linked to higher mortality after intestinal transplantation. Identifying these features aids in managing infectious risks.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Infectious disease
Background:
- Intestinal transplantation is limited by infectious complications, potentially caused by bacterial translocation.
- Bacterial translocation involves the migration of enteric microorganisms to extraintestinal sites.
Purpose of the Study:
- To identify histologic features in intestinal biopsies that predict bacterial translocation within the first month post-transplantation.
- To assess the relationship between histologic findings and infectious complications and mortality.
Main Methods:
- Review of 95 intestinal biopsies from 28 transplant patients.
- Correlation of biopsy findings with extraintestinal microbial cultures (blood, peritoneal cavity).
- Analysis of histologic grades (Ruiz, Park/Chiu) and acute cellular rejection episodes.
Main Results:
- Bacterial translocation occurred in 46.4% of patients, associated with higher 1-year mortality (38.5% vs. 6.7%).
- Positive cultures were linked to higher degrees of mucosal vascular alterations and ischemia/reperfusion injuries (P < .05).
- Positive cultures showed a trend with acute cellular rejection (P = .091); no clinical/surgical factors or immunosuppression were significant.
Conclusions:
- Histologic alterations in small bowel allografts are associated with bacterial translocation.
- Specific histologic features can identify patients at high risk for infectious complications and mortality after intestinal transplantation.
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