A clinicopathologic study of isolated intestinal allografts with preformed IgG lymphocytotoxic antibodies

Wu, Tong; Abu‐Elmagd, Kareem; Bond, Geoffy; Murase, Noriko; Demetris, Anthony J.

doi:10.1016/s0041-1345(02)02650-7

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…Importantly, compared with other solid organ transplants, the intestine represents a highly vascularized and thus very immunogenic allograft. Although data are still scarce, an increasing number of authors have reported the challenges associated with diagnosing and treating AMR following ITX [2,3,[13][14][15]. In most of these studies, the diagnosis of AMR was based on the coincidence of DSAs and acute biopsy-proven rejection [2].…”

Section: Introductionmentioning

confidence: 99%

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Clinical relevance of thede novoproduction of anti-HLA antibodies following intestinal and multivisceral transplantation

et al. 2014

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Summary Despite a negative pretransplant cross‐match, intestinal transplant recipients can mount humoral immune responses soon after transplantation. Moreover, the development of donor‐specific anti‐HLA antibodies (DSAs) is associated with severe graft injury. Between June 2000 and August 2011, 30 patients (median age 37.6 ± 9.8 years) received isolated intestinal transplantations (ITX, n = 18) or multivisceral transplantations (MVTXs, n = 12) at our center. We screened for human leukocyte antigen (HLA) antibodies pre‐ and post‐transplant. If patients produced DSAs, treatment with plasmapheresis and intravenous immunoglobulin (IVIG) was initiated. In the event of DSA persistence and/or treatment‐refractory rejection, rituximab and/or bortezomib were added. Ten patients developed DSAs and simultaneously showed significant signs of rejection. These patients received plasmapheresis and IVIG. Eight patients additionally received rituximab, and two patients were treated with bortezomib. DSA values decreased upon antirejection therapy in 8 of the 10 patients. The development of DSAs following ITX is often associated with acute rejection. We observed that the number of mismatched antigens and epitopes correlates with the probability of developing de novo DSAs. Early diagnosis and therapy, including B‐cell depletion and plasma cell inhibition, are crucial to preventing further graft injury.

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Section: Introductionmentioning

confidence: 99%

“…Characteristics of all ITX and MVTX recipients at our center, including patients who received maintenance immunosuppression and induction therapy according to era I (patients[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] or era II (patients[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

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confidence: 99%

Clinical relevance of thede novoproduction of anti-HLA antibodies following intestinal and multivisceral transplantation

et al. 2014

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“…High panel reactive antibody (PRA) levels are found in 18-30% of patients on the waiting list for intestinal transplantation, a high rate compared with other solid organ transplant recipients (3)(4)(5). Indeed, in our series the incidence of sensitization was significant at 36%.…”

Section: Discussionmentioning

confidence: 53%

“…Unfortunately, many patients who require intestine transplantation are sensitized due to a history of multiple transfusions, line infections, pregnancy and in some cases retransplantation (3)(4)(5). The predominant risk in sensitized patients is the formation of donor-specific antibody (DSA).…”

Section: Introductionmentioning

confidence: 99%

Successful Isolated Intestinal Transplantation in Sensitized Recipients With the Use of Virtual Crossmatching

Hawksworth

Rosen-Bronson

Island

et al. 2012

American Journal of Transplantation

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“…Several case reports have described hyperacute and acute humoral rejection in patients with preformed antibodies, most frequently immunoglobulin G (IgG) lymphocytotoxic antibodies. 23 Wu and colleagues 24 demonstrated that in a small group of ITx patients, 6 of 28 had preformed IgG lymphocytotoxic antibodies. In 5 of 6 with strong positive crossmatch grafts, cyanotic discoloration occurred immediately after reperfusion that resolved within 1 hour.…”

Section: Antibody-mediated Rejectionmentioning

confidence: 99%

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

Remotti

Subramanian²,

Martínez³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein-Barr virus); and immunosuppression-related lymphoproliferative disease. Objective.—To provide a comprehensive review of the literature and illustrate key histologic findings in small-bowel biopsy specimen evaluation of patients with small-bowel or multivisceral transplants. Data Sources.—Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions.—Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.

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A clinicopathologic study of isolated intestinal allografts with preformed IgG lymphocytotoxic antibodies

Cited by 12 publications

References 8 publications

Clinical relevance of thede novoproduction of anti-HLA antibodies following intestinal and multivisceral transplantation

Clinical relevance of thede novoproduction of anti-HLA antibodies following intestinal and multivisceral transplantation

Successful Isolated Intestinal Transplantation in Sensitized Recipients With the Use of Virtual Crossmatching

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

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