Sa1026 Liver Transplantation Among the Baby Boomer Generation in the United States: an Analysis of the United Network for Organ Sharing Registry

Abstract

127 patients had duodenal biopsies taken, amounting to a total of 152 biopsies performed. 87.5% (n: 133/152) of these were histologically normal. Sixteen patients showed abnormal histology and among those 7 patients (43.8%) were on MPA therapy at the time of biopsy. Symptoms in this cohort included diarrhoea (71.4%), weight loss (60%), nausea and vomiting (28.6%) and abdominal pain (14.3%) and occurred at a median of 2.8 years (range 49 3905 days) after initiation of MPA therapy. MPA-associated duodenal changes included shortened villi, an increase in intraepithelial lymphocytes (IELs), an increase in endocrine cell counts and an increase in apoptotic counts. In comparison, agematched patients with confirmed coeliac disease showed similar histological features however, with no increased apoptosis. Conclusion: Diarrhoea following OLT in patients on MPA therapy is a noteworthy entity as it causes significant morbidity and mortality. MPA therapy was associated with abnormal duodenal pathology in a small number of liver transplant cases. Pathologists should be aware of the histological features of MPA-associated duodenal injury, including coeliaclike changes together with an increase in apoptotic counts. CD3 and chromogranin immunohistochemistry can be used to help in this diagnosis. In those found to have abnormal histology, a discontinuation or a reduction in dosage of MPA therapy should be discussed where possible.