Marrow Transplant Pathology is a part of the stem cell transplantation team.
Intestinal transplant is now recognised as the best/optimal treatment option in the management of patients with irreversible short gut syndrome, functional intestinal failure or severe complications of total parenteral nutrition. The clinical management of small bowel transplant patients requires coordinated input from all the members of the transplant team.
The pathologist plays a critical role in assessing the integrity of graft, in the diagnosis of acute and chronic rejection, detection of opportunistic infections and post transplant lymphoproliferative disorders.
Protocol biopsies are taken in the initial post transplant and also when there is a clinical need. These biopsies are taken 2-3 times per week in the first month and 1-2 times per week in the next 2 months. The endoscopist takes multiple biopsies from normal and abnormal looking areas, as rejection maybe focal. All histological findings must be interpreted in the appropriate clinical context. Although non invasive methods for detecting rejection and other complications are being developed, the histological changes in the allograft remains the gold standard for guiding patient management.