Effect of preformed donor-specific antibodies in intestine/ multivisceral transplantation.
Safwan M, Rizzari M, Collins K, Yoshida A, Skorupski S, Fagoaga O, Abouljoud MS, Nagai S. Effect of preformed donor-specific antibodies in intestine/ multivisceral transplantation.. Am J Transplant 2017; 17:369.
Am J Transplant
Aim: To analyze the effect of preformed donor-specific antibodies (DSA) in intestine/ multivisceral transplantation patients. Methods: Retrospective review of preformed and de novo DSAs of all intestine/ multivisceral transplant recipients was performed. The patients with de novo DSAs alone were excluded. Patients were categorized based on the absence (Group 1) and presence (Group 2) of preformed DSAs. Incidence of rejection and outcomes in terms of graft and patient survival were studied. Survival was analyzed using log rank test. Results: Twenty three patients underwent 26 intestinal/multivisceral transplantation between August 2010 and July 2016. Seventeen (65.4%) isolated intestinal, 7 (26.9%) multivisceral and 2 (7.7%) modified multivisceral transplants were performed. Of these, 14 cases belonged to Group 1 and 9 to Group 2. Three cases were excluded due to de novo DSAs alone. Eight (34.8%) cases had positive crossmatches at transplant. Group 2 had significantly higher positive crossmatches (77.8%) compared to Group 1 (7.1%) (p=0.001). The average panel-reactive antibody (PRA) at transplant was 39.0%. PRA was also significantly higher in group 2 with 82.3% compared to group 1 with 11.1% (p<0.001). Ten (43.5%) grafts developed acute rejection with 4 having recurrent episodes. In the Group 1, 7 (50%) cases developed graft rejections with 2 developing recurrent episodes compared to 3 (33.3%) cases of rejection with 2 developing recurrence in Group 2. Rejection rates were similar in both groups (p=0.67). Patient and graft survival were also similar in both groups with median graft and patient survival of 983 days and 1376 days, respectively in group 1 and 1300 days and 1380 days, respectively in group 2 (p=1.0 and 0.38, respectively). Conclusion: Preformed DSA do not seem to influence the occurrence of rejection or graft and patient survival. Larger studies are required to further exam the effect of preformed DSAs on intestinal/multivisceral grafts.