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

Hawksworth, Jason; Rosen-Bronson, Sandra; Island, Eddie; Girlanda, R.; Guerra, Juan Francisco; Valdiconza, C.; Kishiyama, Kazunori; Christensen, Kent Dencker; Kozłowski, S; Kaufman, Stuart S.; Little, Cheryl A.; Shetty, Kirty; Laurin, Jacqueline; Satoskar, Rohit; Kallakury, Bhaskar; Fishbein, Thomas M.; Matsumoto, Cal

doi:10.1111/j.1600-6143.2012.04238.x

Cited by 43 publications

(23 citation statements)

References 51 publications

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“…Until very recently, potential transplant recipients were matched to suitable donors only on the basis of size and blood type. A growing appreciation of the potential for antibody‐mediated rejection has led to more nuanced matching and the implementation of strategies to desensitize recipients with preformed antibodies 45 , 46 …”

Section: Intestinal Transplantationmentioning

confidence: 99%

Surgical Management of Short Bowel Syndrome

Iyer

2014

J Parenter Enteral Nutr

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For patients with short bowel syndrome (SBS), surgery can play an important role in preventing, mitigating, and, in some cases, reversing intestinal failure (IF). During intestinal resection, bowel length should be conserved to the fullest extent possible to avoid dependence on parenteral nutrition (PN). Bowel salvage may be improved by initially preserving tissue of questionable viability and later reevaluating during “second‐look” procedures. Once the patient is stabilized, ostomy reversal and recruitment of distal unused bowel should be prioritized whenever feasible. Following progression to IF, surgical management of SBS depends on the symptoms and anatomical characteristics of the individual patient. For carefully selected patients with rapid intestinal transit and dilated bowel, longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) procedures may provide benefit. Outcomes following STEP and LILT are generally similar, and the choice between these procedures may rest on surgeon preference. For patients with rapid intestinal transit in the absence of bowel dilation, segmental reversal of the small bowel may reduce PN requirements. Intestinal transplantation is the standard of care for patients in whom intestinal rehabilitation attempts have failed and who are at risk of life‐threatening complications of PN. Because patients awaiting isolated intestine transplant show increased survival compared with patients awaiting combined intestine‐liver transplant, early referral of appropriate patients, before the development of advanced liver disease, is critical to enhancing patient outcomes.

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Section: Intestinal Transplantationmentioning

confidence: 99%

Surgical Management of Short Bowel Syndrome

Iyer

2014

J Parenter Enteral Nutr

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“…(75, 76) Recently, the role of donor specific antibody (DSA) has emerged as an important risk factor for rejection, and minimization of preformed DSA with a virtual cross match strategy with long term management of de novo DSA may be improve outcomes following intestine transplantation, particularly in the sensitized liver-exclusion recipient. (77, 78)…”

Section: Intestine Transplantation Outcomesmentioning

confidence: 99%

Visceral transplantation in patients with intestinal-failure associated liver disease: Evolving indications, graft selection, and outcomes

Hawksworth

Desai

Khan

et al. 2018

American Journal of Transplantation

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Intestine failure-associated liver disease (IFALD) is widely recognized as a lethal complication of long-term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with intestinal failure (IF). Visceral transplantation for IFALD includes variants of intestine, liver, or combined liver and intestine transplantation. Graft selection for an individual patient depends on the etiology of intestinal failure, abdominal and vascular anatomy, severity of IFALD, and potential for intestinal rehabilitation. The last decade has witnessed dramatic improvement in the management of IFALD, principally due to improved lipid emulsion formulations and the multi-disciplinary care of the IF patient. As the recognition and treatment of IFALD continues to improve, the requirement of liver-inclusive visceral grafts appears to be decreasing, representing a paradigm shift in the care of the patient with IF. This review highlights the current indications, graft selection and outcomes of visceral transplantation for IFALD.

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“…Many patients are sensitized from multiple surgeries, blood transfusions and infections. Hawksworth et al present a diverse set of benefits from CPRA applied to intestinal transplantation (49). These include optimizing allocation resources and obviating the need for an actual cross-match, which minimizes critical cold ischemic times.…”

Section: Organ Allocationmentioning

confidence: 99%

What’s New, What’s Hot in Solid Organ Transplantation? Summary of the American Transplant Congress 2011

Karp

Mannon

2011

American Journal of Transplantation

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Breakthroughs in basic and clinical science in solid organ transplantation were presented at the American Transplant Congress 2011. Key areas of presentation included the pathogenesis of late allograft failure, immune regulation and tolerance, pathways in allograft injury, electing appropriate patients for transplantation, determining the best allocation schemes to maximize effective utilization, organ preservation, monitoring the alloimmune response and immunosuppressive management. In this review, we present highlights of the meeting. These presentations demonstrate the exciting promise in translating from the bench to affect patient care.

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

Abstract: We evaluated virtual crossmatching (VXM) for organ allocation and immunologic risk reduction in sensi-In conclusion, a VXM strategy to optimize organ allocation enables sensitized patients to successfully undergo isolated intestinal transplantation with acceptable short-term outcomes.

Cited by 43 publications

References 51 publications

Surgical Management of Short Bowel Syndrome

Surgical Management of Short Bowel Syndrome

Visceral transplantation in patients with intestinal-failure associated liver disease: Evolving indications, graft selection, and outcomes

What’s New, What’s Hot in Solid Organ Transplantation? Summary of the American Transplant Congress 2011

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