Small-bowel allograft biopsies in the management of small-intestinal and multivisceral transplant recipients: Histopathologic review and clinical correlations

Context. - Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein- Barr virus); and immunosuppression-related lymphoproliferative disease. Objective. - To provide a comprehensive review of the literature and illustrate key histologic findings in smallbowel biopsy specimen evaluation of patients with smallbowel or multivisceral transplants. Data Sources. - Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions. - Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.