Chronic Allograft Enteropathy Treated with Vedolizumab: A Case Report

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.