IS REJECTION A DIFFUSE OR LOCALIZED PROCESS IN SMALL-BOWEL TRANSPLANTATION

Utilization of endoscopy to both visualize and selectively biopsy an i ntestinal allograft has become the standard for early recognition and treatment of intestinal allograft rejection. Despite the widespread ac ceptance of the need for selective mucosal biopsies, it has not been s hown that the histological features of intestinal allograft rejection are either localized or occur as part of a more diffuse phenomenon wit hin a tubular allograft. To resolve these issues, 88 ileoscopies were performed in 12 small-bowel allograft recipients and mucosal biopsy sa mples were obtained at 5, 10, and 15 cm, respectively, from the ileal stoma. Each mucosal biopsy was labeled, processed, and evaluated indiv idually for the presence and severity of any evidence for allograft re jection. The data obtained suggest that intestinal allograft rejection is a diffuse process, and biopsies obtained randomly from an ileal gr aft are likely to demonstrate evidence of allograft rejection when suc h is present.