Antibody-mediated vascular rejection after intestine transplantation:A case report

Objective To report a case of acute vascular rejection（AVR） after intestine transplantation and summarize its diagnosis and treatment by reviewing its related literature. Methods Panel reactive antibody（PRA） was cross-matched and detected before intestine transplantation.Immune suppression was induced by Alemtuzumab and tacrolimus was used in maintenance treatment after operation.Dark purple stoma mucous membrane of abdominal wall was a typical indication of AVR and the complication of surgery should be excluded before it was diagnosed.Pathological diagnostic criteria for AVR included inflammatory cells,sedimentation of fibrin and platelets,and thrombi in blood vessels,fibrinoid necrosis of artery wall,and positive staining of C4.AVR after intestine transplantation could be classified as grades 0-3 according to the severity of blood vessel injury. Results Lymphocytotoxicity test（LCT） and PRA were negative.The stoma for transplantation became dark 40h after operation.B type ultrasonic examination showed that the transplanted intestine was patent.Bloody fluid was found at the stoma 44h after operation.Exploratory laporatomy revealed that the viability of transplanted intestine was lost,thus severe AVR（grade 3） was diagnosed with C4d positively stained. Conclusion Dark purple stoma mucous membrane is a typical clinical manifestation of AVR.Complication of surgery should be excluded before it is diagnosed.Early diagnosis and active treatment can avoid intestine transplantation for mild AVR.However,the resection rate of transplanted intestine for severe AVR is extremely high.