P2.28: Eosinophilic gastrointestinal disease following intestinal transplant

Abstract

Introduction:Eosinophilic gastrointestinal disease (EGID) has been reported to be of higher incidence following solid organ transplantation than the general population. We reviewed the EGID incidence following single organ intestinal transplant or multi-visceral transplants at our institution. Methods:We completed a retrospective chart review on twenty-six patients who were followed at our center after intestinal or multi-visceral transplant between the years of 2003–2016. Patients transplanted prior to age of 18 and followed at least 1 year from transplant were included. Histological criteria were used for EGID diagnoses. Eosinophil infiltration of the native gastrointestinal (GI) tract only was included and not the allograft. Comparisons were done using Fisher’s exact test and Mann-Whitney two-tailed test. Results:Of the 26 individuals followed for minimum of a year after intestinal or multi-visceral transplant, 15 (15/26, 58%) individuals were subsequently diagnosed with EGID. Twelve patients (12/26, 46%) were diagnosed with eosinophilic esophagitis (EoE), one of which also had eosinophilic gastritis (EG). One patient had EG and eosinophilic colitis (EC) and one each with EC and EG. The mean age at diagnosis of EGID was 7.56 ± 5.10 years and EGID developed on average 5.20 ± 3.59 years from transplant. There was no statistically significant difference between age at time of transplant in EGID vs non-EGID (2.35 ± 2.91 vs 4.08 ± 5.07). All (15/15) patients who developed EGID were on tacrolimus at the time of diagnosis and thirteen (13/15, 87%) underwent immunosuppression induction with anti-thymocyte globulin. Five (5/15, 33%) patients also developed food allergies post-transplant, including 2 (2/11, 18%) in the non-EGID group. Three patients (3/15, 20%) were diagnosed with PTLD prior to EGID diagnosis, while no (0/11) PTLD diagnoses occurred in the non-EGID group. Rejection occurred at a greater frequency in the EGID group than the non-EGID groups (13/14, 93% vs 7/11, 64%). Mean time from first rejection episode to developing EGID was 3.74 ± 2.74 years. Eleven (11/13, 85%) EGID patients we have data on were taking at least a partial PO diet at time of diagnosis, one each of PO formula and formula by G-Tube. Conclusion:The prevalence of EGID disorders in intestinal transplants is much higher than the general population and other single solid organ transplants. Close screening for EGID development following intestinal transplant is warranted.