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Post-Transplant Events

Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy

Bone Marrow Transplantation volume 44, pages 43–49 (2009)Cite this article

Abstract

Intestinal transplant-associated microangiopathy (i-TAM) is an important complication after allogeneic hematopoietic SCT. From 1997 to 2006, 87 of 886 patients with diarrhea after transplantation received colonoscopic biopsy. i-TAM, GVHD and CMV colitis were diagnosed histopathologically. The median duration from transplantation to the onset of diarrhea was 32 days (range: 9–130 days) and that from the onset of diarrhea to biopsy was 12 days (range: 0–74 days). The median maximal amount of diarrhea was 2 l/day (range: 130–5600 ml/day). Histopathological diagnosis included i-TAM (n=80), GVHD (n=26), CMV colitis (n=17) and nonspecific findings (n=2) with overlapping. Among 80 patients with i-TAM, abdominal pain was a major symptom, and only 11 patients fulfilled the proposed criteria for systemic TAM. Non-relapse mortality (NRM) among patients without resolution of diarrhea was 72% and i-TAM comprised 57% of NRM. NRM was 25% among patients without intensified immunosuppression, but was 52, 79 and 100% among those with intensified immunosuppression before diarrhea, after diarrhea, and before and after diarrhea, respectively. In conclusion, i-TAM is a major complication presenting massive refractory diarrhea and abdominal pain, which causes NRM. Avoiding intensified immunosuppression that damages vascular endothelium until the resolution of i-TAM may improve transplant outcome.

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Authors and Affiliations

  1. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Y Inamoto, T Nishida, S Nishiwaki, T Oba, Y Kodera & K Miyamura

  2. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Inamoto, T Nishida, M Murata, M Yanada & T Naoe

  3. Department of Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    M Ito, M Fujino & N Hirabayashi

  4. Department of HSCT Data Management, Nagoya University School of Medicine, Nagoya, Japan

    R Suzuki

  5. Department of Hematology, Meitetsu Hospital, Nagoya, Japan

    H Iida

  6. Department of Hematology and Oncology, Konan Kosei Hospital, Konan, Japan

    A Kohno & Y Morishita

  7. Department of Hematology, Anjo Kosei Hospital, Anjo, Japan

    M Sawa

  8. Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    R Ichihashi

  9. Department of Gastroenterology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    T Yamaguchi

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  1. Y Inamoto
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  12. T Naoe
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  13. R Ichihashi
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for the Nagoya Blood and Marrow Transplantation Group

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Correspondence to Y Inamoto.

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Inamoto, Y., Ito, M., Suzuki, R. et al. Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy. Bone Marrow Transplant 44, 43–49 (2009). https://doi.org/10.1038/bmt.2008.419

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  • DOI: https://doi.org/10.1038/bmt.2008.419

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