title: Association between donor-specific antibodies and acute rejection and resolution in small bowel and multivisceral transplantation.
abstract: 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.
authors.affiliation: Division of Transplantation, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
authors.forename: Hsin-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Eddie R
authors.initials: ER
authors.lastname: Island
authors.forename: Jei-Wen
authors.initials: JW
authors.lastname: Chang
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gonzalez-Pinto
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tryphonopoulos
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Debbie
authors.initials: D
authors.lastname: Weppler
authors.forename: Oscar K S
authors.initials: OK
authors.lastname: Lee
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000737:chemistry; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006680:HLA Antigens / Q000378:metabolism; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D014180:Transplantation / Q000379:methods*; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D006680:HLA Antigens