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Updated: Jul 5, 2026
Small Bowel Transplantation In Mice
Published on: August 20, 2007
Small bowel transplantation in children: an immunohistochemical study of intestinal grafts
G Fromont1, N Cerf-Bensussan, N Patey
1Service d'Anatomie et de Cytologie Pathologiques, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Neonatal small bowel allografts show better tolerance in children with short bowel syndrome. Immunohistochemistry aids in monitoring transplants and reveals lower immunogenicity in neonatal grafts, predicting fewer rejection episodes.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Surgical pathology
Background:
- Short bowel syndrome necessitates intestinal transplantation.
- Graft rejection is a significant challenge in small bowel allografting.
- Neonatal grafts may offer improved outcomes compared to adult or pediatric grafts.
Purpose of the Study:
- To define immunohistochemical markers of rejection in intestinal allografts.
- To compare the immunogenicity of neonatal versus older donor small bowel grafts.
- To assess the utility of immunohistochemistry in predicting transplant rejection.
Main Methods:
- Immunohistochemical analysis of 85 intestinal biopsy specimens from pediatric patients.
- Evaluation of immune cell infiltrates (CD3+, CD8+, CD25+, CD68+) and adhesion molecules (MHC class II, E-selectin).
- Comparison of neonatal grafts with grafts from pediatric and adult donors.
Main Results:
- Acute rejection associated with CD3+, CD8+, CD25+ T cells, CD68+ macrophages, MHC class II on enterocytes, and E-selectin on endothelial cells.
- Immunohistochemistry predicted rejection 48 hours prior via CD25+ T cells.
- Neonatal grafts showed no significant difference in macrophages or selectin expression but lacked MHC class II on epithelium and had fewer intraepithelial lymphocytes.
Conclusions:
- Immunohistochemistry is a valuable tool for monitoring intestinal transplant rejection.
- Neonatal small bowel allografts exhibit reduced immunogenicity, potentially explaining their better clinical tolerance.
- Lower expression of MHC class II on neonatal epithelium and fewer intraepithelial lymphocytes contribute to improved graft acceptance.
Abstract:
Seven children with short bowel syndrome underwent small bowel allografting. Episodes of early rejection were observed in five patients who received a graft from paediatric or adult donors but not in two patients who received a neonatal graft. This study aimed, firstly, to define immunohistochemical parameters accompanying rejection and, secondly, to compare immunohistochemical parameters in neonatal grafts with those in grafts from older donors. An immunohistochemical analysis was performed on 85 intestinal biopsy specimens taken for monitoring the transplant. Acute histological rejection was associated with pericryptic infiltrates of CD3+TcR alpha beta + T cells containing clusters of CD8+ cells, numerous CD25+ cells, and increased numbers of CD68+ macrophages. These changes were associated with the appearance of major histocompatibility (MHC) class II antigens on crypt enterocytes and with an appreciable increase in the expression of E-selectin on mucosal endothelial cells. Immunohistochemistry was useful in predicting rejection by showing the appearance of pericryptic CD25+ T cells 48 hours before the first histological lesions of crypt necrosis. Comparison of neonatal grafts with grafts from older donors did not show any significant difference in the density of CD68+ macrophages or in the endothelial expression of intercellular adhesion molecule-1, vascular cell adhesion molecule-1, or E-selectin. In contrast to grafts from older donors, however, neonatal grafts did not express MHC class II antigens on epithelial cells and contained very low numbers of intraepithelial lymphocytes. These data indicate, firstly, that immunohistochemistry is useful for monitoring intestinal transplants and, secondly, that the better clinical tolerance of neonatal allografts may be related to the lower immunogenicity of the neonatal epithelium.
