Skip Navigation LinksHome > February 2013 - Volume 37 - Issue 2 > Histology of Intestinal Allografts: Lymphocyte Apoptosis and...
American Journal of Surgical Pathology:
doi: 10.1097/PAS.0b013e31826393fe
Original Articles

Histology of Intestinal Allografts: Lymphocyte Apoptosis and Phagocytosis of Lymphocytic Apoptotic Bodies Are Diagnostic Findings of Acute Rejection in Addition to Crypt Apoptosis

Tsuruyama, Tatsuaki MD, PhD*,†; Okamoto, Shinya MD; Fujimoto, Yasuhiro MD; Yoshizawa, Atsushi MD; Yoshitoshi, Elena MD; Egawa, Hiroto MD§; Nakase, Hiroshi MD; Aini, Wulamujiang MD*; Miyao, Masashi MD; Tamaki, Keiji MD; Yamabe, Hirohiko MD*; Haga, Hironori MD*; Uemoto, Shinji MD

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Abstract

Acute rejection of a small-bowel transplant is often difficult to diagnose due to complicated immune responses. The present study aimed to elucidate the specific immune responses involved in intestinal transplant rejection. We correlated immunohistologic findings with an increase in crypt apoptosis, which has been commonly accepted as a criterion for the diagnosis of acute cellular rejection (ACR). Of 8 patients who received an intestinal allograft at Kyoto University Hospital, biopsy specimens from 7 patients were assessed immunohistologically with antibodies against 20 types of lymphocytic antigens including CD3, CD4, CD8, CD79a, CD20, IgG, and T-cell receptor, along with assessment of the patients’ clinical courses. It was revealed that, in addition to apoptotic crypts, T-lymphocyte apoptosis and phagocytosis of apoptotic bodies in the lamina propria of villi were findings of ACR; both were observed in all cases. Immunostaining of the Fas ligand, one of the apoptosis-inducing molecules, was useful for the identification of the apoptotic bodies in the lamina propria of villi. Apoptotic body phagocytosis may be a surrogate diagnostic finding of grafts undergoing ACR.

© 2013 Lippincott Williams & Wilkins, Inc.

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