Immunological complications beyond rejection after intestinal transplantation

Intestinal transplantation (ITx) represents a major immunological challenge as the bidirectional exchange of donor's and recipient's immune cells delivers a graft highly chimeric and immunogenic. Therefore, there is a higher risk for immunological complications. It is important to understand the prevalence, natural history and mechanisms of other immunological complications, beyond rejection, to better understand the implications of ITx.

In recent studies, graft-versus-host disease (GVHD) holds a high mortality (43-70%). Apart from increasing or modifying immunosuppression, there are not other new therapies at this time. Inflammatory bowel disease (IBD) in solid organ transplant recipients has been estimated to be 10 times that of the general population. In the ITx recipient, it is not clear whether IBD is an autonomous disorder or a different phenotype of acute rejection. There are some studies suggesting that anti-tumour necrosis factor α (anti-TNFα) may have a role in preventing or treating rejection. According to recent studies, the incidence of autoimmune hemolytic anemia is 11% and a large proportion of these patients will respond to conventional therapy.

Rejection, GVHD, IBD-like disorder, autoimmune disorders and food allergies are among the more significant immunological complications after ITx. We need further studies to comprehend the risk factors and pathophysiology that will lead to better markers and innovative therapies that will impact survival.