Journal of Clinical Pathology and Laboratory Medicine

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Mini Review - Journal of Clinical Pathology and Laboratory Medicine (2024) Volume 6, Issue 3

Pathological Spectrum of Gastrointestinal Lesions in Post-Transplant Biopsies

Ron Williams *

Department of Surgical Pathology, the University of Queensland, Brisbane, Australia

*Corresponding Author:
Ron Williams
Department of Surgical Pathology, The University of Queensland, Brisbane, Australia
E-mail: williams@hotmail.com.au

Received:07-May-2024, Manuscript No. AACPLM -24-141964; Editor assigned: 09-May-2024, PreQC No AACPLM -24-141964 (PQ) Reviewed:23-May-2024, QC No. AACPLM -24-141964 Revised:27-May-2024, Manuscript No. AACPLM -24-141964 (R); Published:13-June-2024, DOI:10.35841/aacplm-6.3.210

Citation: Williams R. Pathological Spectrum of Gastrointestinal Lesions in Post-Transplant Biopsies. J Clin Path Lab Med. 2024;6(5):210

Introduction

The spectrum of pathological lesions observed in post-transplant gastrointestinal mucosal biopsies, it's crucial to delve into the complexities of transplant medicine and the unique challenges faced in the gastrointestinal tract. Post-transplant patients often undergo regular surveillance biopsies to monitor for complications, including rejection and infection, which can manifest in various ways in the gastrointestinal mucosa [1].

Organ transplantation has revolutionized the management of end-stage organ failure, offering a chance for extended survival and improved quality of life for patients. However, the success of transplantation relies heavily on effective immunosuppressive therapy to prevent rejection while balancing the risk of infections and other complications. Gastrointestinal complications are among the most frequent and challenging issues encountered post-transplant, often necessitating mucosal biopsies for diagnosis and management [2].

Immunological rejection remains a primary concern in post-transplant patients, including in the gastrointestinal tract. Acute Cellular Rejection (ACR) and Antibody-Mediated Rejection (AMR) can affect the gastrointestinal mucosa, presenting with various histopathological features. ACR typically involves lymphocytic infiltration and epithelial injury, whereas AMR manifests as vascular changes and deposition of complement components within the mucosal layers [3].

Infections pose significant risks post-transplant due to immunosuppression. Opportunistic infections such as cytomegalovirus (CMV), Epstein-Barr Virus (EBV), and fungal infections like candidiasis and aspergillosis commonly involve the gastrointestinal mucosa. These infections can mimic rejection histologically or exacerbate rejection processes, making accurate diagnosis crucial for appropriate management [4].

Immunosuppressive drugs used post-transplant can lead to specific mucosal changes. For instance, calcineurin inhibitors (e.g., tacrolimus, cyclosporine) can cause mucosal injury and ulceration, predisposing patients to infections and other complications. Sirolimus and everolimus may induce mucosal ulcerations and gastrointestinal bleeding, necessitating careful monitoring and adjustment of therapy [5].

Post-Transplant Lymphoproliferative Disorders (PTLD) represents a spectrum of lymphoid proliferations ranging from benign polyclonal lymphoproliferations to malignant lymphomas. These disorders can involve the gastrointestinal tract, presenting with mucosal ulcerations, masses, or lymphadenopathy. Histologically, PTLD can resemble lymphomas seen in immunocompetent individuals but often require special studies for accurate diagnosis [6].

Ischemic complications, such as ischemic colitis, can occur post-transplant due to vascular thrombosis or hypo perfusion. These lesions may present with mucosal ulcerations, hemorrhage, or strictures, necessitating prompt recognition to prevent bowel ischemia and perforation. Vascular lesions, including vasculitis, can also manifest in the gastrointestinal mucosa post-transplant, requiring careful evaluation for appropriate management [7].

Graft-Versus-Host Disease (GVHD) in allogeneic hematopoietic stem cell transplantation, GVHD can affect the gastrointestinal tract, leading to mucosal damage and inflammation. Histologically, GVHD presents with crypt apoptosis, epithelial injury, and lymphocytic infiltration. It is a significant cause of morbidity and mortality post-transplant, requiring immunosuppressive therapy and supportive care [8].

Neoplastic Complications Post-transplant patients are at increased risk of developing de novo malignancies, including gastrointestinal cancers such as colorectal carcinoma. Surveillance biopsies may reveal dysplastic changes or early cancers, prompting early intervention to improve outcomes. Histopathological evaluation plays a crucial role in distinguishing these lesions from other inflammatory or infectious processes [9].

Miscellaneous Lesions are Other less common but significant lesions observed in post-transplant gastrointestinal biopsies include drug-induced injury (e.g., nonsteroidal anti-inflammatory drug-induced enteropathy), metabolic disorders (e.g., amyloidosis), and rare infectious agents (e.g., strongyloidiasis). Each requires specific diagnostic approaches and tailored management strategies based on histopathological findings [10].

Conclusion

In conclusion, the spectrum of pathological lesions observed in post-transplant gastrointestinal mucosal biopsies is diverse and multifactorial, encompassing immunological, infectious, drug-related, neoplastic, ischemic, and other etiologies. Accurate histopathological evaluation is paramount for guiding clinical management decisions, optimizing immunosuppressive therapy, and improving patient outcomes. Continued research into these lesions is essential to refine diagnostic criteria and therapeutic approaches in the evolving field of transplant pathology.

References

  1. Gautam A. Gastrointestinal complications following transplantation. Surg Clin. 2006;86(5):1195-206.

    2. Indexed at, Google Scholar , Cross Ref

  2. Angarone M, Snydman DR, AST ID Community of Practice. Diagnosis and management of diarrhea in solid?organ transplant recipients: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13550.

    3. Indexed at, Google Scholar , Cross Ref

  3. Cheng YW, Phelps E, Ganapini V, et al. Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: a multicenter experience. Am J Transplant. 2019;19(2):501-11

    4. Indexed at, Google Scholar , Cross Ref.

  4. Mazer LM, Méan M, Tapper EB. Who orders a head CT?: perceptions of the cirrhotic bleeding risk in an international, multispecialty survey study. J Clin Gastroenterol. 2017;51(7):632-8..

    5. Indexed at, Google Scholar , Cross Ref

  5. Rodríguez?Perálvarez M, Germani G, Tsochatzis E, et al. Predicting severity and clinical course of acute rejection after liver transplantation using blood eosinophil count. Transpl Int. 2012;25(5):555-63.

    6. Indexed at, Google Scholar , Cross Ref

  6. Haidar G, Singh N. Viral infections in solid organ transplant recipients: novel updates and a review of the classics. J Clin Gastroenterol. 2017;30(6):579-88.

    7. Indexed at, Google Scholar , Cross Ref

  7. Gilljam M, Chaparro C, Tullis E, et al. GI complications after lung transplantation in patients with cystic fibrosis. Chest. 2003;123(1):37-41.

    8. Indexed at, Google Scholar , Cross Ref

  8. Paul S, Escareno CE, Clancy K, et al. Gastrointestinal complications after lung transplantation. J Heart Lung Transplant. 2009;28(5):475-9.

    9. Indexed at, Google Scholar , Cross Ref

  9. Ponticelli C, Passerini P. Gastrointestinal complications in renal transplant recipients. Transpl Int. 2005;18(6):643-50.

    10. Indexed at, Google Scholar , Cross Ref

  10. Ganoza A, Mazariegos GV, Khanna A. Current status of graft-versus-host disease after intestinal transplantation. CURR OPIN ORGAN TRAN. 2019;24(2):199-206.

    11. Indexed at, Google Scholar , Cross Ref

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