Multidrug-resistant Klebsiella Pneumoniae Infection Led to Resection of the Graft in a Small Bowel Transplant Recipient: A Case Report and Review of the Literature

Review

Author: Li, Xiaohua ; Gao, Ruiqi ; Liang, Jiayi ; Zhang, Ying ; Zhou, Haikun ; Ji, Gang ; Wang, Weidong ; Yue, Chao ; Mo, Zhenchang ; Wu, Xiao ; Yang, Qinchuan ; Yu, Pengfei

BACKGROUNDInfection due to multidrug-resistant Klebsiella pneumoniae is a common cause of graft resection after small bowel transplantation. We report a failed case in which the intestinal graft was resected 18 days after the operation due to postoperative infection with multidrug-resistant K pneumoniae and a literature review of other common causes of small bowel transplantation failure have been reported.METHODSA female, 29 years of age, underwent partial living small bowel transplantation for short bowel syndrome. After the operation, the patient was infected with multidrug-resistant K pneumoniae, even though various anti-infective regimens were employed. It further developed into sepsis and disseminated into intravascular coagulation, leading to exfoliation and necrosis of the intestinal mucosa. Finally, the intestinal graft had to be resected to save the patient's life.RESULTSMultidrug-resistant K pneumoniae infection often affects the biological function of intestinal grafts and can even lead to necrosis. Other common causes of failure, including postoperative infection, rejection, post-transplantation lymphoproliferative disorder, graft-vs-host disease, surgical complications, and other related diseases, were also discussed throughout the literature review.CONCLUSIONSPathogenesis due to diverse and interrelated factors makes the survival of intestinal allografts a great challenge. Therefore, only by fully understanding and mastering the common causes of surgical failure can the success rate of small bowel transplantation be effectively improved.

01 Jul 2013·Transplantation ProceedingsQ4 · MEDICINE

Cell Stress Response in Rat Chronic Small Bowel Allograft Rejection

Q4 · MEDICINE

Article

Author: J. Li ; Y. Li ; J. Wang

BACKGROUNDWe sought to assess the expression of five cell stress molecules: Heat shock protein (HSP)-60, HSP-70, interferon (IFN)-α, rat retinoic acid early induible-1 like transcript (RRLT), and vasoactive intestinal peptide (VIP) during rat chronic small bowel allograft rejection.METHODSA rat model of small bowel allograft rejection was induced on postoperative day 90 using F344 rat as donor and Lewis rat as recipient.RESULTSWe demonstrated increased expression of lamina propria HSP-60 (mean rank grade 8.3 and 3.2, respectively), graft RRLT (relative mRNA amount 5.1 ± 1.8 and 3.0 ± 1.3, respectively) and IFN-α (relative mRNA amount 108.3 ± 49.2 and 59.2 ± 22.0, respectively) in allograft group compared with the isograft group.CONCLUSIONThese data suggest the presence of cell stress during chronic small bowel allograft rejection.

27 Dec 2010·TransplantationQ2 · MEDICINE

Toll-Like Receptor 4 Contributes to Small Intestine Allograft Rejection

Q2 · MEDICINE

Article

Author: Esquivel, Carlos O. ; Martinez, Olivia M. ; Phillips, Lori ; Ito, Takashi ; Castillo, Ricardo O. ; Krams, Sheri M. ; Wang, Mouer ; Kambham, Neeraja ; Higgins, John

BACKGROUNDAlthough outcomes for small intestine transplantation (SIT) have improved in recent years, allograft rejection rates remain among the highest of solid organ grafts. The high load of commensal bacteria in the small intestine may contribute through activation of the toll-like receptor (TLR) pathway. In this study, we examine the participation of TLR4 in acute allograft rejection in an orthotopic mouse model of SIT.METHODSWild-type C57Bl/6 (H-2b) or TLR49(-/-) (H-2b) mice were transplanted with syngeneic (C57Bl/6), allogeneic (BALB/c; H-2d), or F1 (BALB/cxC57Bl/6; H-2d/b) vascularized, orthotopic small intestine grafts. Graft recipients were killed on days 2 to 6 posttransplant. Serum cytokines were measured by Luminex, and tissue was obtained for histology and quantitative real-time polymerase chain reaction.RESULTSBALB/c grafts transplanted into C57Bl/6 recipients exhibited mixed inflammatory infiltrates, destruction of the mucosa, and significant apoptosis. TLR2 and TLR4 transcripts were modestly increased in syngeneic grafts on days 2 and 6 compared with native bowel, whereas TLR2 and TLR4 were significantly increased on days 2 and 6 in allogeneic grafts. Although fully mismatched and F1 grafts were rejected by C57Bl/6 recipients (mean survival time=8.2 and 9.3 days, respectively), graft survival was significantly prolonged in TLR4(-/-) recipients (mean survival time=10.6 and 14.3 days, respectively). Proinflammatory cytokines were markedly reduced in TLR4(-/-) graft recipients.CONCLUSIONSSmall intestine graft survival is prolonged in the absence of TLR4, suggesting that gut flora associated with the graft may augment alloimmune responses through TLR4. Thus, the TLR pathway may be a novel therapeutic target for improving SIT allograft survival.

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