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


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)


Zenapax 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


64 months Good intestinal graft function

Graft loss (22.04.04)


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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