Safe and Successful Treatment of Acute Cellular Rejection of an Intestine and Abdominal Wall Transplant With Vedolizumab

Trentadue, Guido; Kats-Ugurlu, Gürsah; Blokzijl, Tjasso; Diercks, Gilles F.H.; Haveman, Jan Willem; Faber, Klaas Nico; Dijkstra, Gerard

doi:10.1097/txd.0000000000000973

Cited by 20 publications

(14 citation statements)

References 30 publications

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“…AW-VCA was performed in five groups (Miami, 2 23 24 25 Bologna, 1 26 27 28 29 Oxford, 30 31 32 33 34 35 36 Duke, 6 37 and Groningen 38 39 groups). An overlap of sample population was found among studies that made overall outcome estimations challenging.…”

Section: Resultsmentioning

confidence: 99%

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Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

Bustos

Escandón

Santamaría

et al. 2021

J Reconstr Microsurg

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Background Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with intestinal transplantation (ITx) or multivisceral abdominal transplantation (MVTx). Since the introduction of this procedure, several studies have been published reporting their experience. This study aims to present a scoping review looking at all available evidence-based medicine information to understand the most current surgical techniques and clinical outcomes. Methods This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for scoping reviews checklist. A comprehensive research strategy of several databases was conducted. Results A total of 31 studies were included in this review, which comprised animal, cadaveric, and human studies. In human studies, four surgical techniques with high flap survival rates and low complication rates were found. In cadaveric studies, it was shown that the use of iliofemoral cuff-based flaps provided adequate tissue perfusion to the abdominal wall graft. Also, the use of thoracolumbar nerves have been described to provide functionality to the AW-VCA and prevent long-term muscle atrophy. Conclusion AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. The future holds a promising evolution of a functional AW-VCA, though surgeons must face and overcome the challenge of distorted anatomy frequently present in this population. Forthcoming studies with a better level of evidence are required to evaluate functionality and differences between surgical techniques.

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Section: Resultsmentioning

confidence: 99%

“…AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. Its use is recommended in patients undergoing concomitant ITx and MVTx, 25 Cipriani et al, 26 and Selvaggi et al 24 , Weissenbacher et al, 36 Erdmann et al, 37 , Atia et al 6 and Trentadue et al 38…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

Bustos

Escandón

Santamaría

et al. 2021

J Reconstr Microsurg

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“…Intestinal tissue was stored in an ice-cold University of Wisconsin (UW) tissue preservation solution until further use. Immunohistochemistry was performed as described previously ( Trentadue et al, 2020 ). Briefly, paraffin-embedded tissue sections of 4 μm from intestinal tissue from resection material were cut and placed on Starfrost slides (3054-1, Klinipath, VWR, Breda, Netherlands).…”

Section: Methodsmentioning

confidence: 99%

HIF1α-Dependent Induction of TFRC by a Combination of Intestinal Inflammation and Systemic Iron Deficiency in Inflammatory Bowel Disease

Fagundes

Bourgonje

et al. 2022

Front. Physiol.

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Background and Aims: Iron deficiency (ID) is a frequent extra-intestinal manifestation in patients with Inflammatory Bowel Disease (IBD), who often do not respond to iron supplementation. Iron is a cofactor for hydroxylases that suppress the hypoxia-inducible factor-1α (HIF1α), a transcription factor regulating iron homeostasis. We hypothesized that iron deficiency affects mucosal HIF1α activity in IBD.Methods: IBD patients (n = 101) were subdivided based on iron status (ferritin levels or transferrin saturation) and systemic inflammation (C-reactive protein levels). 154 corresponding ileal and colonic biopsies were analyzed for differential expression of 20 HIF1α pathway-associated genes and related to iron and inflammation status. In vitro expression of selected HIF1α pathway genes were analyzed in wild-type and HIF1A-null Caco-2 cells.Results: Gene expression of the mucosal HIF1α pathway was most affected by intestinal location and inflammatory status. Especially, ileal mucosal TFRC expression, encoding the transferrin receptor TFR1, was increased in inflamed tissue (p < 0.001), and further enhanced in ID. Accordingly, TFRC expression in inflamed tissue associated negatively with serum iron levels, which was not observed in the non-inflamed mucosa. The HIF1α pathway agonist DMOG increased TFRC expression in Caco-2 cells, which was blunted in HIF1A-null cells.Conclusion: We demonstrate that inflammation and anatomical location primarily determine HIF1α pathway activation and downstream TFRC expression in the intestinal mucosa. IBD patients with ID may benefit from treatment with HIF1α-agonists by 1) increasing TFRC-mediated iron absorption in non-inflamed tissue and 2) decreasing mucosal inflammation, thereby improving their responsiveness to oral iron supplementation.

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“…Antibodies against cell adhesion molecules, such as the α4β7 integrin blocker vedolizumab are already used in IBD. Trentadue et al ( 38 ) describe a case of acute rejection after bowel transplant being successfully treated with vedolizumab. Fitzpatrick et al ( 17 ) used single cell RNA sequencing to demonstrate transcriptionally distinct tissue resident T cell subtypes from the donor after bowel transplant.…”

Section: Proposed New Drug Therapiesmentioning

confidence: 99%

Innovations in Immunosuppression for Intestinal Transplantation

Dogra

Hind

2022

Front. Nutr.

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It has been 57 years since the first intestinal transplant. An increased incidence of graft rejection has been described compared to other solid organ transplants due to high immunogenicity of the bowel, which in health allows the balance between of dietary antigen with defense against pathogens. Expanding clinical experience, knowledge of gastrointestinal physiology and immunology have progress post-transplant immunosuppressive drug regimens. Current regimes aim to find the window between prevention of rejection and the risk of infection (the leading cause of death) and malignancy. The ultimate aim is to achieve graft tolerance. In this review we discuss advances in mucosal immunology and technologies informing the development of new anti-rejection strategies with the hope of improved survival in the next generation of transplant recipients.

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Safe and Successful Treatment of Acute Cellular Rejection of an Intestine and Abdominal Wall Transplant With Vedolizumab

Cited by 20 publications

References 30 publications

Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

Abdominal Wall Vascularized Composite Allotransplantation: A Scoping Review

HIF1α-Dependent Induction of TFRC by a Combination of Intestinal Inflammation and Systemic Iron Deficiency in Inflammatory Bowel Disease

Innovations in Immunosuppression for Intestinal Transplantation

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