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Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies.

Publication ,  Journal Article
Parekh, R; Kazimi, M; Skorupski, S; Fagoaga, O; Jafri, S; Segovia, MC
Published in: Transplant Proc
March 2016

BACKGROUND: We describe our experience using a modified protocol for immunosuppression for intestine transplantation across a positive crossmatch. Patients who underwent transplantation in 2013 were evaluated over a 12-month period for rejection and infectious events with comparison to procedure-matched controls on our standard protocol of immunosuppression. PATIENTS AND METHODS: We used a modified protocol for intestine and multivisceral transplantation for patients with a positive flow crossmatch. In addition to our standard protocol, patients with positive crossmatch were given rituximab and intravenous immunoglobulin (IVIg) preoperatively. DSA was sent for clinical evaluation at monthly intervals. Patients were screened for rejection by endoscopic evaluation. RESULTS: Four patients underwent transplantation within a single year across a positive crossmatch. Two received isolated intestine transplants and 2 had multivisceral transplantation (MVT). During the 12-month follow-up, 1 patients had an episode of severe acute cellular rejection, which was managed with increased immunosuppression. None of the patients had episodes of cytomegalovirus infection. One patient developed major infection and 3 patients developed minor bacterial infections. Among procedure-matched controls with negative final crossmatch on standard management (no preoperative rituximab or IVIg), 2 developed mild acute cellular rejection and 2 developed minor infections. One developed cytomegalovirus viremia with invasion to the colonic mucosa. CONCLUSIONS: We report our protocol for immunosuppression for IT and MVT across a positive crossmatch. This allowed transplantation despite the presence of a positive crossmatch, with low rejection rates but potentially increased risk for major infections compared to the negative crossmatch controls on our standard protocol.

Duke Scholars

Published In

Transplant Proc

DOI

EISSN

1873-2623

Publication Date

March 2016

Volume

48

Issue

2

Start / End Page

489 / 491

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Middle Aged
  • Male
  • Intestines
  • Immunosuppression Therapy
  • Immunoglobulins, Intravenous
  • Humans
  • Histocompatibility Testing
  • Graft Rejection
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Parekh, R., Kazimi, M., Skorupski, S., Fagoaga, O., Jafri, S., & Segovia, M. C. (2016). Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies. Transplant Proc, 48(2), 489–491. https://doi.org/10.1016/j.transproceed.2015.10.084
Parekh, R., M. Kazimi, S. Skorupski, O. Fagoaga, S. Jafri, and M. C. Segovia. “Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies.Transplant Proc 48, no. 2 (March 2016): 489–91. https://doi.org/10.1016/j.transproceed.2015.10.084.
Parekh R, Kazimi M, Skorupski S, Fagoaga O, Jafri S, Segovia MC. Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies. Transplant Proc. 2016 Mar;48(2):489–91.
Parekh, R., et al. “Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies.Transplant Proc, vol. 48, no. 2, Mar. 2016, pp. 489–91. Pubmed, doi:10.1016/j.transproceed.2015.10.084.
Parekh R, Kazimi M, Skorupski S, Fagoaga O, Jafri S, Segovia MC. Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies. Transplant Proc. 2016 Mar;48(2):489–491.
Journal cover image

Published In

Transplant Proc

DOI

EISSN

1873-2623

Publication Date

March 2016

Volume

48

Issue

2

Start / End Page

489 / 491

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Middle Aged
  • Male
  • Intestines
  • Immunosuppression Therapy
  • Immunoglobulins, Intravenous
  • Humans
  • Histocompatibility Testing
  • Graft Rejection