Rejection of Transplanted Small Intestine
Definition
- Immune mediated injury against transplanted small intestine manifested by crypt epithelial injury
Diagnostic Criteria
- Increased apoptotic bodies in crypts
- >6 bodies / 10 crypts
- Crypt injury
- Cytoplasmic basophilia
- Nuclear enlargement and hyperchromasia
- Mucin depletion
- Loss of Paneth cells
- Distortion of villous and crypt architecture
- Mucosal ulceration in severe cases
Grading
- Indeterminate
- Up to 6 apoptotic bodies per 10 crypts
- Mild
- >6 apoptotic bodies per 10 crypts
- Moderate
- Confluent apoptosis
- Increased inflammation
- Epithelial injury
- Severe
/Exfoliative
- Features of moderate rejection plus mucosal ulceration
- May have arteritis
- Must be distinguished from CMV ulcers
- Poor prognosis
Neeraja Kambham MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting : May 9, 2007
