Spectrum of Pathological Lesions Observed in Post-Transplant Gastrointestinal Mucosal Biopsies

  • Merin Jaison Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
  • Pushpa Mahadevan Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
  • Resha Menon Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
Keywords: solid organ transplantation, colitis, transplant recipients, gastrointestinal tract, kidney transplantation, cytomegalovirus


Background: Gastrointestinal mucosal biopsies in post-transplant patients reveal diverse pathologies, including infections and post-transplant inflammatory bowel disease (IBD). Immunosuppressants, crucial for preventing rejection, pose risks such as nausea, diarrhea, peptic ulcers, infections, and cancers. Diagnosing post-transplant colitis is challenging due to similar clinical and histological features. Pathologies include drug-induced colitis, infection-related colitis, graft-versus-host disease (GVHD), de novo IBD, neoplasms, post-transplant lymphoproliferative diseases (PTLD), and non-specific colitis. Each requires specific treatments, highlighting the need for a multidisciplinary approach. This study evaluates these lesions in our tertiary care center. Methods: A retrospective study analyzed 46 post-renal and liver transplant patients who underwent GI endoscopy/colonoscopy biopsies at VPS Lakeshore, Kochi, between January 2017 and December 2022. Variables such as patient age, gender, presenting complaint, time from transplantation to symptoms, and histopathological diagnosis were analyzed using SPSS software. Results: From 2017 to 2022, 46 out of 985 transplant recipients underwent GI biopsies (39 kidney, 7 liver). The cohort was predominantly male (93.5%) with a mean age of 54.93 years. Diarrhea was the primary symptom (45.7%), followed by dyspepsia and anemia, occurring on average 23 months post-transplant. Pathological findings included infection-related colitis (26.1%), drug-induced colitis (8.7%), de novo IBD (2.2%), neoplasms (2.2%), post-transplant lymphoproliferative diseases (2.2%), non-specific colitis (32.6%), and no significant pathology (26.1%). Conclusion: Post-transplant gastrointestinal diseases are complex, impacting the health and quality of life of recipients. Timely diagnosis and personalized management are crucial. A multidisciplinary approach is essential for effective care, and continued research and clinical efforts are vital for improving outcomes.


Pittman ME, Jessurun J, Yantiss RK. Differentiating posttransplant inflammatory bowel disease and other colitides in renal transplant patients. Am J Surg Pathol. 2017;41(12):1666-74.

de Andrade LG, Rodrigues MA, Romeiro FG, Garcia PD, Contti MM, de Carvalho MF. Clinicopathologic features and outcome of mycophenolate-induced colitis in renal transplant recipients. Clin Transplant. 2014;28:1244-8.

Gioco R, Corona D, Ekser B, Puzzo L, Inserra G, Pinto F, et al. Gastrointestinal complications after kidney transplantation. World J Gastroenterol. 2020;26(38):5797-811.

Wong NA. Gastrointestinal pathology in transplant patients. Histopathology. 2015;66:467-79.

Bamias G, Boletis J, Argyropoulos T, Skalioti C, Siakavellas SI, Delladetsima I, et al. Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea. World J Gastroenterol. 2010;16(30):3834-40.

Gioco R, Puzzo L, Patanè M, Corona D, Trama G, Veroux P, et al. Post-transplant colitis after kidney transplantation: clinical, endoscopic and histological features. Aging (Albany NY). 2020;12(24):24709-20.

Lin SH, Wu KT, Wang CC, Liu TT, Eng HL, Chiu KW. Immunohistochemistry staining-proven cytomegalovirus colitis in living donor liver transplantation. Viruses. 2022;15(1):115.

Nepal S, Navaneethan U, Bennett AE, Shen B. De novo inflammatory bowel disease and its mimics after organ transplantation. Inflamm Bowel Dis. 2013;19(7):1518-27.

Original Article