TY - JOUR
T1 - Association between donor-specific antibodies and acute rejection and resolution in small bowel and multivisceral transplantation
AU - Tsai, Hsin Lin
AU - Island, Eddie R.
AU - Chang, Jei Wen
AU - Gonzalez-Pinto, Ignacio
AU - Tryphonopoulos, Panagiotis
AU - Nishida, Seigo
AU - Selvaggi, Gennaro
AU - Tekin, Akin
AU - Moon, Jang
AU - Levi, David
AU - Woodle, E. Steve
AU - Ruiz, Phillip
AU - Weppler, Debbie
AU - Lee, Oscar K.S.
AU - Tzakis, Andreas G.
PY - 2011/9/27
Y1 - 2011/9/27
N2 - Background. Donor-specific antibodies (DSA) are associated with acute kidney graft rejection, but their role in small bowel/multivisceral allograft remains unclear. We carried out a prospective study to understand the impact of DSA in the setting of intestinal allograft rejection. Methods. Thirteen patients (15 grafts) were serially evaluated for DSA levels pre-and posttransplant. DSA was determined by Luminex and the results were interpreted as fluorescence intensity (FI), with FI more than 3000 considered positive. Results. The clinical rejection episodes in allografts were significantly associated with the presence of DSA (P=0.041).We obtained 291 biopsy samples from graft ileum and date-matched DSA assay reports. Sixty-three (21.65%) of the biopsies showed acute rejection. The appearance of DSA were preformed (n=5, anti-human leukocyte antigen class II=3, anti-class I and II=2), de novo (n=4, 15.25±4.72 days after transplantation, anti-class II=1, and anti-class I and II=3) and never (n=6). Among the 63 biopsies, 30(47.6%) had significant correlations with positive DSA (kappa=0.30, P<0.001) and manifested severe rejection grade (P=0.009). Conclusions. In this cohort of small bowel/multivisceral transplantation patients, there was a high incidence of DSA. The presence of DSA should alert the clinical team of a higher risk of rejection, and reduction of the FI is clinically associated with resolution. Serial endoscopy guided biopsies combined with simultaneous DSA measurement in postintestinal transplantation follow-up is an effective means of screening for cellular and humoral-based forms of acute rejection.
AB - Background. Donor-specific antibodies (DSA) are associated with acute kidney graft rejection, but their role in small bowel/multivisceral allograft remains unclear. We carried out a prospective study to understand the impact of DSA in the setting of intestinal allograft rejection. Methods. Thirteen patients (15 grafts) were serially evaluated for DSA levels pre-and posttransplant. DSA was determined by Luminex and the results were interpreted as fluorescence intensity (FI), with FI more than 3000 considered positive. Results. The clinical rejection episodes in allografts were significantly associated with the presence of DSA (P=0.041).We obtained 291 biopsy samples from graft ileum and date-matched DSA assay reports. Sixty-three (21.65%) of the biopsies showed acute rejection. The appearance of DSA were preformed (n=5, anti-human leukocyte antigen class II=3, anti-class I and II=2), de novo (n=4, 15.25±4.72 days after transplantation, anti-class II=1, and anti-class I and II=3) and never (n=6). Among the 63 biopsies, 30(47.6%) had significant correlations with positive DSA (kappa=0.30, P<0.001) and manifested severe rejection grade (P=0.009). Conclusions. In this cohort of small bowel/multivisceral transplantation patients, there was a high incidence of DSA. The presence of DSA should alert the clinical team of a higher risk of rejection, and reduction of the FI is clinically associated with resolution. Serial endoscopy guided biopsies combined with simultaneous DSA measurement in postintestinal transplantation follow-up is an effective means of screening for cellular and humoral-based forms of acute rejection.
KW - Acute rejection
KW - Donor-specific antibody
KW - Multivisceral transplantation
KW - Small bowel transplantation
UR - http://www.scopus.com/inward/record.url?scp=80052688843&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e318229f752
DO - 10.1097/TP.0b013e318229f752
M3 - Article
C2 - 21804443
AN - SCOPUS:80052688843
SN - 0041-1337
VL - 92
SP - 709
EP - 715
JO - Transplantation
JF - Transplantation
IS - 6
ER -