2013 - ISBTS 2013 Symposium

This page contains exclusive content for the member of the following sections: TTS, IXA, ITA

Oral Communications 2

8.218 - Eosinophilic esophagitis after intestinal transplantation in children

Presenter: Khalid, Khan, , United States
Authors: Khalid Khan1, Chirag Desai1, Rafaele Girlanda1, Eddie Island1, Cal Matsumoto1, Thomas Fishbein1, Kaufman Stuart1

Eosinophilic esophagitis after intestinal transplantation in children

Khalid Khan1, Chirag Desai1, Rafaele Girlanda1, Eddie Island1, Cal Matsumoto1, Thomas Fishbein1, Kaufman Stuart1

1Transplant, MedStar Georgetown University Hospital, Washington, DC, United States

Background: The presence of an increased eosinophil count in the esophageal mucosa is most commonly a result of gastroesophageal reflux and eosinophilic esophagitis (EoE). The latter is an uncommon problem that has been increasingly reported in the general population over the past 3 decades. The prevalence of EoE has also been shown to have increased during this time and it is estimated to occur in up to 0.1% of the pediatric population. In a proportion of children EoE may be related to food allergies. Food allergy is reported after solid organ transplantation.  Here we examined the nature of esophageal eosinophilia in our pediatric patients who have undergone intestinal transplantation.
Method: We reviewed patient charts and databases of the Transplant Institute at the MedStar Georgetown University Hospital. Data on pediatric patients transplanted between 2004 and 2012 was examined. As part of the institute protocol upper endoscopy is performed annually in pediatric patients from the first year after intestinal transplantation.
Results: Of 79 patients that had undergone intestinal transplantation 19 (24%) were found to have eosinophilia on mucosal biopsy of the esophagus. Of these 13 (68%) were male. The age at transplantation was, mean 2.7 + 2.3 years, median 2.1, range 0.6-9.3. Indications for transplantation were, gastroschesis (n= 5), necrotizing enterocolitis (n= 4), malrotation/volvulus (n= 4), pseudoobstruction (n= 4), intestinal atresia (n= 2). Then majority of transplanted grafts were liver and small bowel (n=11, 2 included a colon). The remaining grafts were, isolated small bowel (n=3), small bowel with colon (n=2) and multivisceral transplants (n=2). The time from transplantation to maximal eosinophilia was, mean 4.1 + 2.0 years, median 3.7, range 0.7-7.6. Endoscopic and pathologic reports available in 17/19. In 11/17 (65%) the endoscopic appearance of the esophagus was typical of EoE (characterized by linear furrows or trachealization), in 2/17 (12%) the visual features favored reflux esophagitis and in 4/17 (24%) the esophagus appeared normal. Histological evidence of EoE (>15 eosinophils/high power field) was present 12/17 (71%) and 9 of these 12 (75%) had the typical endoscopic and histologic findings of EoE indicating 9/79 (11%) prevalence of EoE in our patients. Regression showed a strong inverse correlation between the year of transplantation and the time to development of esophageal eosinophilia (Figure), R sq. = 72.3, p=0.00.
Conclusion: Eosinophilic esophagitis occurs in patients who have undergone intestinal transplantation. Patients should be screened routinely.

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.



Staff Directory
This email address is being protected from spambots. You need JavaScript enabled to view it.


The Transplantation Society
International Headquarters
505 Boulevard René-Lévesque Ouest
Suite 1401
Montréal, QC, H2Z 1Y7