Chronic Allograft Enteropathy Treated with Vedolizumab: A Case Report

Guido Trentadue; Gursah Kats-Ugurlu; Tjasso Blokzijl; Jan Willem Haveman; Klaas Nico Faber; Gerard Dijkstra

doi:10.1016/j.transproceed.2024.11.021

Chronic Allograft Enteropathy Treated with Vedolizumab: A Case Report

Transplant Proc. 2024 Dec 4:S0041-1345(24)00582-7. doi: 10.1016/j.transproceed.2024.11.021. Online ahead of print.

Authors

Guido Trentadue¹, Gursah Kats-Ugurlu², Tjasso Blokzijl³, Jan Willem Haveman⁴, Klaas Nico Faber⁵, Gerard Dijkstra⁶

Affiliations

¹ Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: [email protected].
² Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁴ Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁵ Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁶ Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

PMID: 39638713
DOI: 10.1016/j.transproceed.2024.11.021

Abstract

Introduction: The most common cause of late graft loss in intestinal transplantation is chronic allograft enteropathy (CAE). The diagnosis is often delayed because of late symptoms and signs, and the only available treatment is graft enterectomy. We present the first case of CAE successfully treated with a gut-specific integrin blocker.

Case report: We present a patient who developed CAE 15 years after transplantation and was treated with vedolizumab, a gut-specific integrin blocker that is used for inflammatory bowel disease, thereby avoiding complete graft resection. We show the clinical, endoscopic, radiological, serological, and histopathological course of CAE beginning with discovery of the first signs of disease until 15 months after the start of vedolizumab treatment.

Conclusion: To our knowledge, this case represents the first use of vedolizumab in such a circumstance and provides evidence of its usefulness as a rescue therapy for chronic intestinal rejection to, at least, extend graft survival.