ENDOSCOPIES IN PEDIATRIC SMALL-INTESTINAL TRANSPLANT RECIPIENTS - 5 YEARS EXPERIENCE

Objective: Intestinal transplantation has become an option as a treatm ent for permanent intestinal failure. Endoscopy is an essential tool i n assessing the intestinal allograft after intestinal transplantation. The aim of this study was to analyze our experience using endoscopy i n intestinal transplant recipients. Methods: This was a retrospective review of endoscopic and histological reports in 41 children who recei ved an intestinal transplant between 1990 and 1995 at Children's Hospi tal of Pittsburgh. Results: A total of 1273 endoscopies was performed of which 760 were ileoscopies via allograft ileostomy, 273 were upper endoscopies, and 240 were colonoscopies. One hundred four rejection ep isodes were documented histologically in 32 patients, 6 days to >4 yr after transplantation. Most episodes were mild and easily treated with increased immunosuppression; however, severe rejection with mucosal e xfoliation was seen in nine patients. Rejection sometimes involved onl y part of the allograft. Endoscopic appearance alone without biopsies was sensitive enough to diagnose only 63% of the rejection episodes. E pstein-Barr and cytomegalovirus infections occurred in 11 and eight pa tients, respectively, and involved both native bowel and allograft in some. Complications of endoscopy were few: one perforation, three epis odes of bleeding, and three episodes of transient respiratory compromi se. Conclusions: Endoscopy is an essential tool in the postoperative a ssessment of intestinal transplant recipients. Frequent surveillance i leoscopies with biopsies should be performed after transplantation. If patients clinically deteriorate with fever, diarrhea, bacteremia, or gastrointestinal bleeding and a dear cause is not elucidated by ileosc opy, an upper endoscopy with biopsies is indicated. (C) 1998 by Am. Ce ll. of Gastroenterology).