近年来小肠移植在患者和移植物的存活率方面取得了重大进展。尽管如此，小肠急性细胞性排斥依然施术后处理中最具有挑战性的方面。我们收集了我中心11年间209例小肠移植患者的资料行回顾性分析，分析了需要临床处理的活检证实的290次排斥反应。我们发现，相对于多内脏移植，单独小肠移植和肝小肠移植患者所有排斥反应发病率和严重排斥反应发病率都较高。2项排斥时间变量对于移植物生存率有明显的负作用：严重排斥的发生和>=21天的排斥反应。多内脏移植受者严重排斥反应的低发生率可能是由于供者淋巴组织的增多和移植物内供者来源的免疫感受态细胞增多的结合。因此，为了防止严重和/或长期的排斥时间的发生，小肠移植存活率的提高需要更有效的监测和处理方案。

Intestinal transplantation has evolved over the years with major improvements in patient and graft survival. Acute cellular rejection of the intestine, however, still remains one of the most challenging aspects of postoperative management. We analyzed retrospectively collected data from 209 recipients of primary intestinal grafts at our institution over the past 11 years. A total of 290 episodes of biopsy-proven rejection requiring clinical treatment were analyzed. Rejection episodes doubled in length, on average, with each increasing grade (mild, moderate, severe). We observed increased incidence of overall rejection and particularly severe rejection in recipients of isolated intestinal and liver-intestine grafts in comparison with multivisceral grafts. Two rejection history variables had a significant negative impact on graft survival: the occurrence of a severe rejection episode and a rejection episode lasting >/=21 days. The lower incidence rate of severe rejection in recipients of multivisceral grafts might be due to a combination of increased donor lymphatic tissue and larger load of donor-derived immune competent cells present in the graft. The development of more effective monitoring and treatment protocols to prevent the occurrence of severe and/or lengthy rejection episodes is of critical importance for intestinal graft survival.

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