Recurrence of Crohns Disease

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Crohn's disease is considered to be an autoimmune disorder. Therefore, the possibility of recurrence within the graft is an important issue. So far, only two well-documented cases of recurrent disease have been reported. The first case was a 33-year-old female, who underwent small-bowel transplantation in December 1994. After induction with donor bone marrow infusion and with OKT3, immunosuppres-sion consisted of tacrolimus and methylpred-nisolone. Only 7 months post-transplant did the

Fig. 4. Graft survival according to centre size: >100, number of transplants more than hundred; 11-100, number of transplants between 11 and 100; 1-10, transplants per centre

Fig. 3. Graft survival according to pretransplantation status of the recipients. Home, patients awaiting transplantations at home; hospitalized, patients awaiting transplantation at the hospital

Table 1. Intestinal transplants for Crohn's disease (Innsbruck experience)

No. Initials Age Gender Underlying disease

Date Immuno- Complication suppression

Outcome

Crohn's disease, 14.08.98

short-bowel syndrome (after two resections)

Crohn's disease, 10.04.00

short-bowel syndrome, impaired renal function

Loss of 1st intestinal graft 05.06.02

Crohn's disease, short-bowel syndrome, renal failure (pyelonephritis)

ATG TAC Aza P

Zenapax TAC Aza P

ATG TAC Aza P

07.07.03 ATG + kidney" TAC Aza P

Bleeding from anastomosis rejection

Recurrent line sepsis two acute rejections

T-cell lymphoma intestinal graft

Well

64 months Good intestinal graft function

Graft loss (22.04.04)

Well

Good intestinal graft function 42 months on dialysis

Intestinal graft removed 29 months Good kidney function

" The kidney was transplanted separate from the small bowel

ATG, anti-thymocyte globulin; TAC, tacrolimus; Aza, azathioprine; P, prednisone

patient develop epithelial granulomas, which is characteristic of Crohn's disease. Resection of a bowel segment became necessary and the graft was eventually removed 17 months after transplantation. Histology revealed recurrent Crohn's disease and no signs of chronic or acute rejection [16].

The second case was a 19-year-old male who had an isolated small-bowel transplant in 1994. Maintenance immunosuppression included tacrolimus, azathioprine, and prednisolone. At 8 years post-transplantation, recurrent Crohn's disease was diagnosed that responded to prednisolone [17].

At another center, two patients transplanted for Crohn's disease were reported to have a significant incidence of granulomas in the graft. Both patients remained asymptomatic for as long as 40 months after transplantation [14]. Even if there are only few reports on disease recurrence, it has to be recognized that Crohn's disease can recur despite high-level immunosuppression.

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