The endoscopic surveillance of the transplanted small intestine: a single center experience and a proposal for a grading score. (1st February 2018)

• Record Type: Journal Article
• Authors: Varkey, Jonas; Stotzer, Per-Ove; Simrén, Magnus; Herlenius, Gustaf; Oltean, Mihai
• Is Part Of: Scandinavian journal of gastroenterology. Volume 53:Number 2(2018)
• Page Start: 134
• Page End: 139
• Publication Date: 2018-02-01
• Subjects: Monitoring -- acute rejection -- ileoscopy -- severity of illness index -- Intestinal mucosa -- transplantation -- small intestine -- calprotectin; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.1080/00365521.2017.1411523
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Objective: Microscopic examination of endoscopic biopsies forms the basis of acute cellular rejection (ACR) monitoring after intestinal transplantation (ITx). The endoscopy findings during acute rejection (AR) are known but a grading system for its severity is lacking. We designed and implemented a five-stage grading score based on acknowledged endoscopic features of AR, to allow a faster preliminary diagnosis of AR and intra- and interpatient comparisons. Methods: Two investigators reviewed and graded the endoscopy reports after 28 ITx using a novel score and correlated the results with pathology findings. Results: We reviewed 512 ileoscopies: 370 examinations (74%) were normal (G0), 59 had mild alterations (erythema, edematous villi-G1) and 36 showed moderate changes (erosions, blunted villi-G2); 17 ileoscopies revealed advanced changes (ulcerations, villus loss-G3). In 18 endoscopies the changes were severe (mucosal loss-G4). Inter-reviewer agreement was very good (kappa = 0.81). Biopsies from 86 endoscopy sessions (17%) indicated ACR with 63 cases having moderate or severe ACR. For mild ACR the sensitivity of the score was 29% and the specificity was 86% whereas the positive (PPV) and negative predictive values (NPVs) were 14% and 93% respectively. During advanced ACR the sensitivity and specificity were 92% and 86%, respectively whereas the PPV and NPV were 49% and 98% respectively. Conclusions: Endoscopy alone has a limited ability to reliably diagnose intestinal ACR. We suggest a novel grading score summarizing ACR findings and allowing comparisons between intestinal graft endoscopies.