Updates on antibody-mediated rejection in intestinal transplantation

Wu, Guosheng

doi:10.5500/wjt.v6.i3.564

Cited by 11 publications

(10 citation statements)

References 52 publications

(63 reference statements)

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“…Antibody mediated rejection (AMR) is a major contributor to rejection risk and allograft loss in solid organ transplantation [ 1 , 2 ]. AMR diagnostic criteria were first established in cardiac [ 3 ] and renal [ 4 ] transplantation and have recently been described for pancreas [ 5 ] and lung transplantation [ 6 ] and, although historically controversial, are proposed for liver [ 7 ] and intestinal [ 8 ] allografts as well. AMR incidence is approximately 10–20% in cardiac [ 9 ], 5–8% in renal [ 10 ], 4–25% in lung [ 11 , 12 ], and 24% in liver [ 13 ] transplant.…”

Section: Introductionmentioning

confidence: 99%

Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection

Butler

Valenzuela

Thomas

et al. 2017

Journal of Immunology Research

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Consistent with Dr. Paul Terasaki's “humoral theory of rejection” numerous studies have shown that HLA antibodies can cause acute and chronic antibody mediated rejection (AMR) and decreased graft survival. New evidence also supports a role for antibodies to non-HLA antigens in AMR and allograft injury. Despite the remarkable efforts by leaders in the field who pioneered single antigen bead technology for detection of donor specific antibodies, a considerable amount of work is still needed to better define the antibody attributes that are associated with AMR pathology. This review highlights what is currently known about the clinical context of pre and posttransplant antibodies, antibody characteristics that influence AMR, and the paths after donor specific antibody production (no rejection, subclinical rejection, and clinical dysfunction with AMR).

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Section: Introductionmentioning

confidence: 99%

Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection

Butler

Valenzuela

Thomas

et al. 2017

Journal of Immunology Research

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“… Although feasibility studies into the role of molecular and biomarker profiling of inflammation in the context of the transplant pancreas have been reported, this is currently an area of potential development, rather than yet having a recognized diagnostic role, as for example is seen in kidney transplantation . Histological features of duodenal rejection, especially antibody‐mediated, remain relatively poorly defined, potentially making it difficult to identify duodenal rejection as an underlying cause for duodenal leaks . This may explain why duodenal rejection was not identified in explanted grafts with duodenal leaks that had histological evidence of APR.…”

Section: Discussionmentioning

confidence: 99%

Early allograft pancreatectomy—Technical failure or acute pancreatic rejection?

Wallace

Bunnett

Fryer

et al. 2019

Clinical Transplantation

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Introduction “Technical failure” is still perceived to be a frequent cause of graft loss after pancreas transplantation. However, some early graft losses currently attributed to technical failure could be due to unrecognized acute pancreas rejection (APR). Methods We investigated the apparent incidence of APR in cases of early allograft pancreatectomy (EAP) that had previously been attributed to technical failure. We performed an analysis of 198 patients who underwent pancreas transplantation between January 2009 and January 2016 and identified all those with EAP within 90 days of transplantation. Explanted grafts of EAP recipients were re‐examined histologically to evaluate for evidence of APR using current Banff criteria. Results Twenty‐three EAPs were identified (11.6%; 23/198). APR was identified histologically in 9 out of the 15 recipients who lost their grafts due to duodenal leaks or recurrent peripancreatic collections, but was not identified in any of the patients whose grafts were lost due to thrombosis or ischemia. Interpretation Unsuspected APR appears common in the explanted grafts of recipients who have undergone EAP for apparently “technical” reasons. We suggest that EAP should be defined as a technical failure only when APR of the pancreas (or duodenum) has been excluded by histological analysis.

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“…The histological criteria for a diagnosis of acute cellular rejection (ACR) were as described previously [ 22 ]. A diagnosis of acute antibody-mediated rejection (ABMR) is based on clinical evidence of graft dysfunction, high PRA levels with circulating donor-specific antibody (DSA) and pathological evidence of tissue injury and C4d deposition [ 23 ]. A new rejection episode is defined as the occurrence of new clinical symptoms with characteristic pathologies and at least one normal mucosal biopsy between two rejection events.…”

Section: Methodsmentioning

confidence: 99%

Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection

Cruz

2017

Gastroenterology Report

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Background and aimsA co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury; however, detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to date. The aim of the study was to compare immune-mediated injury, causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant (LITx) or liver-exclusive intestinal transplant (LETx).MethodsBetween May 2000 and May 2010, 212 adult patients undergoing LITx (n =76) and LETx (n =136) were included. LITx underwent either liver combined intestinal or full multivisceral transplantation. LETx underwent either isolated intestinal or modified multivisceral transplantation.ResultsDuring 44.9 ± 31.4 months of follow-up, death-censored intestinal graft survival was significantly higher for LITx than LETx (96.9%, 93.2% and 89.9% vs 91.4%, 69.3% and 60.0% at 1, 3 and 5 years; p =0.0001). Incidence of graft loss due to rejection was higher in LETx than in LITx (30.9% vs 6.6%; p <0.0001), while infection was the leading cause of graft loss due to patient death in LITx (25.0% vs 5.1%; p <0.0001). Despite similar immunosuppression, the average number (0.87 vs 1.42, p =0.02) and severity of acute cellular rejection episode (severe grade: 7.9% vs 21.3%; p =0.01) were lower in LITx than in LETx. Incidence of acute antibody-mediated rejection was also significantly lower in LITx than in LETx (3.6% vs 15.2%; p =0.03). Incidence of chronic rejection was reduced in LITx (3.9% vs 24.3%; p =0.0002).ConclusionsIntestinal allografts with a liver component appear to decrease risk of rejection but increase risk of infection. Our findings emphasize that LITx has characteristic immunologic and clinical features. Lower immunosuppression may need to be considered for patients who undergo LITx to attenuate increased risk of infection.

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Updates on antibody-mediated rejection in intestinal transplantation

Cited by 11 publications

References 52 publications

Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection

Not All Antibodies Are Created Equal: Factors That Influence Antibody Mediated Rejection

Early allograft pancreatectomy—Technical failure or acute pancreatic rejection?

Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection

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