Outcomes of Intestinal Biopsies Which Are Indeterminate for Rejection Following Intestine Transplant

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: We evaluated the impact of “indeterminate for rejection” (IFR) biopsy results and subsequent clinical outcomes. We aim to evaluate whether changes in immunosuppressive medications and cytomegalovirus (CMV) status at the time of IFR biopsy influence the likelihood of a subsequent biopsy also being classified as IFR or showing a definitive rejection outcome. Methods: Retrospective analysis of adult patients who underwent intestinal transplantation, including those who received multi-organ transplants with intestine with at least one biopsy classified as IFR. Data collected includes immunosuppressive changes, subsequent biopsy results, and infection status. Results: We evaluated 31 patients with long term follow-up following IFR biopsy. 17 (55%) were female. Mean age at time of transplant was 48 years (22-68). 18 (57.9%) patients had intestine transplant only, 13 had multiorgan transplant. There were 84 recorded instances of IFR biopsy results. 54 instances (64%) led to immunosuppression changes, while 30 (36%) did not. 4% of patients in the immunosuppression change group (ICG) and 7% in the no-change group (NCG) had positive CMV PCR at the time of biopsy. In ICG, 69% of cases were negative for rejection on follow-up biopsy. In NCG, 60% were negative for rejection on follow-up biopsy. Persistent indeterminate classification was observed in 9.3% of ICG cases and 20% of NCG. Mild rejection occurred in 20% of ICG cases and 17% of NCG cases. Moderate rejection was seen in 1.9% of ICG cases and 0% of NCG cases. Severe rejection was seen in 0% of ICG cases and 3.3% of NCG cases. There were no statistically significant differences between the two groups (Odds Ratio [OR] = 1.27, 95% Confidence Interval [CI]: 0.47-3.38, p = 0.6). A secondary analysis focused on only the first instance of an IFR biopsy for each patient. 71% of these cases were ICG. 77% of these ICG cases showed subsequent results negative for rejection. 44% of NCG cases showed negative subsequent results for rejection. Persistent IFR occurred in 4.5% of ICG cases and 22% of NCG. Mild rejection occurred in 14% of ICG cases and 22% of NCG. Moderate rejection occurred in 4.5% of ICG and 0% of NCG. Severe rejection occurred in 0% of ICG and 11% of NCG. Conclusions: While medication adjustments were frequently implemented following IFR biopsy, their effect on subsequent biopsy results was not statistically significant. The majority of patients who underwent immunosuppression changes had negative subsequent biopsy outcomes, similar to those without immunosuppression changes. The study highlights the complexity of managing IFR biopsy results in transplant recipients and underscores the need for further research to better understand the appropriate response to IFR biopsy. CITATION INFORMATION: Malick A., Tepe G., Nagai S., Muszkat Y., Beltran N., Pietrowsky T., Jafri S. Outcomes of Intestinal Biopsies Which Are Indeterminate for Rejection Following Intestine Transplant AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Malick: None.

Volume

25

Issue

8

First Page

S839

Last Page

S840

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