Use of vedolizumab in pediatric intestinal transplant rejection

Blockade of α4β7 integrin cell adhesion receptors on activated lymphocytes with the monoclonal antibody vedolizumab (VDZ) is efficacious in treatment of inflammatory bowel disease and most probably intestinal graft versus host disease (GVHD) after stem cell transplantation. Recently, there have been reports indicating that VDZ may be similarly effective in the treatment of acute rejection after intestinal transplantation (ITx). Herein, we report 3 additional cases. Mucosal recovery was achieved in 2 of the 3 patients, within 6 days after the first VDZ dose in one and with early restoration of enteral nutrition in the other. There was no response to VDZ in the third case. Complications potentially attributable to VDZ included graft pneumatosis and late-onset histoplasmosis. These cases describe both benefits and limitations of VDZ in ITx. They also suggest that VDZ may be useful in post-ITx rejection prophylaxis and for the treatment of intestinal GVHD.