PMC5563400_01
Histological sections of the transplanted bowel taken in April 2016 prior to complete explantation. (a) shows ulceration with a fibrinous exudate and granulation tissue formation consistent with severe colitis. (b) shows ulceration to the level of the muscularis propria as well as abundant ulcer slough consistent with our assertion that the regenerative state of the bowel could not be assessed adequately by histology.
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Subsequent ITx biopsies revealed increased numbers of apoptotic bodies in the crypts in association with severe mucosal ulceration and granulation tissue, now suggestive of combined acute rejection of both abdominal wall and intestinal graft (Figures 1(a) and 1(b)).
Macroscopic appearance of the bowel on endoscopy prior to right hemicolectomy in February 2016. This image demonstrates a severely circumferentially ulcerated transplant ileum consistent with severe rejection.
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However, despite continued steroid and antithymocyte globulin therapy, he suffered ongoing intestinal inflammation and based on the macroscopic appearances of his transplanted bowel (Figure 2()), a right transplant hemicolectomy was performed in February 2016.