Endoscopy Following Pediatric Intestinal Transplant

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Transplant Medicine

Background:

• Gastrointestinal endoscopy is essential for managing pediatric intestinal transplant (ITx) recipients.
• Biopsies are the gold standard for diagnosing ITx rejection.

Purpose of the Study:

• To review a 23-year single-center endoscopic experience in pediatric ITx recipients.
• To describe procedural indications, findings, and complications.

Main Methods:

• Retrospective review of endoscopy and pathology reports.
• Analysis of ITx recipients under 18 transplanted between 1991 and 2013.

Main Results:

• 1770 endoscopic procedures in 1014 sessions were performed.
• Increased stool output and surveillance were common indications.
• 162 episodes of biopsy-proven rejection diagnosed; 45% had normal endoscopic appearance.
• Procedural complication rate was 1.8%.

Conclusions:

• Endoscopy with biopsy is vital for ITx graft surveillance, rejection diagnosis, and treatment follow-up.
• Endoscopic appearance does not reliably correlate with rejection histology.
• High complication rates and complex anatomy necessitate experienced transplant centers; noninvasive biomarkers are needed.