Small bowel transplantation: Current status and new developments in allograft monitoring
Purpose of review: This review aims to summarize the current practices for intestinal allograft monitoring, including the newest developments in the past year. The gold standard has been histologic examination of endoscopy-directed allograft biopsy. Recent findings: Plasma citrulline levels, immunohistochemical staining of biopsy specimens, and stool calprotectin levels have all been examined as alternative methods of allograft monitoring. The aims of each diagnostic test are variable and include improvement in the accuracy of biopsy interpretation, early diagnosis of rejection, or a noninvasive method of monitoring the intestinal allograft that might avoid or decrease the risks associated with endoscopic biopsy. Summary: Although the results are extremely limited for each of the tests currently being studied in humans, there is good reason to believe that significant progress over the next few years will satisfy all these aims. The development of accurate alternative methods of allograft monitoring will undoubtedly improve the results of intestinal transplantation by allowing lowering of immunosuppression levels in patients not at risk for rejection and limiting exposure to toxicities associated with these medications. © 2005 Lippincott Williams & Wilkins.
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