Abstract. The aim of this study was to investigate the application of plasma exchange in small intestinal transplantation between ABO blood type-incompatible patients. A small intestinal transplantation case between ABO-incompatible individuals is hereby presented and analyzed. The main treatment included plasma exchange, splenectomy and immunosuppression. The patient undergoing small intestinal transplantation exhibited stable vital signs. A mild acute rejection reaction developed ~2 weeks after the surgery, which the patient successfully overcame. The subsequent colonoscopy and pathological examination revealed no signs of acute rejection. In conclusion, plasma exchange in combination with anti-immune rejection therapy proved to be an effective scheme for the management of small intestinal transplantation between ABO-incompatible patients.
IntroductionSmall intestinal transplantation is a procedure involving several aspects, such as anti-immune rejection treatment, transplanted organ procurement, surgical technique, perioperative management and prevention of infection following surgery (1). Rejection and infection are the two major issues compromising surgical success. Currently, allogeneic small intestinal transplantation appears to be a viable treatment option for intestinal failure and short bowel syndrome. Small intestinal transplantation between ABO-incompatible individuals may cause a severe rejection response, affecting the survival of the intestinal recipient (1-3). The ABO blood antigens are glycoproteins on the membrane surface of red blood cells. These antigens are also detectable on the vascular endothelial cells of the grafted small intestine. The small intestinal transplantation between ABO-incompatible individuals may lead to a series of complement reactions. Once the complement system is activated, it may quickly occlude the blood vessels and cause thrombosis, resulting in graft failure (4). This is the report of a successful small intestinal transplantation case between ABO-incompatible individuals.
Case reportPatient and donor characteristics. The patient was a 17-year-old female, weighing 40.5 kg, with A Rh + blood type and an anti-B antibody titer of 1:64, who underwent a small intestinal and partial colon resection following acute diffuse peritonitis and mesenteric artery thrombosis. The donor was the recipient's father (43-years old; blood type, AB).Plasma exchange and antibody titers. Rituximab (Rh + ) was used to reduce the patient's B lymphocyte numbers 18 days prior to surgery. In order to reduce the patient's antibody titers, the double-filtration and separation method was used for plasma exchange (5). The first plasma exchange was performed 9 days prior to transplantation. A total of 4 plasma exchanges were performed. Therefore, the blood IgM antibody titers were reduced to 1:1. The patient's small intestine was resected due to of serve necrosis. After 1 year and 2 months, a section of the small intestine (length, 190 cm) from the donor was transplanted into the recipient. The titer...