title: Successful isolated intestinal transplantation in sensitized recipients with the use of virtual crossmatching.
abstract: We evaluated virtual crossmatching (VXM) for organ allocation and immunologic risk reduction in sensitized isolated intestinal transplantation recipients. All isolated intestine transplants performed at our institution from 2008 to 2011 were included in this study. Allograft allocation in sensitized recipients was based on the results of a VXM, in which the donor-specific antibody (DSA) was prospectively evaluated with the use of single-antigen assays. A total of 42 isolated intestine transplants (13 pediatric and 29 adult) were performed during this time period, with a median follow-up of 20 months (6-40 months). A sensitized (PRA ≥ 20%) group (n = 15) was compared to a control (PRA < 20%) group (n = 27) to evaluate the efficacy of VXM. With the use of VXM, 80% (12/15) of the sensitized patients were transplanted with a negative or weakly positive flow-cytometry crossmatch and 86.7% (13/15) with zero or only low-titer (≤ 1:16) DSA. Outcomes were comparable between sensitized and control recipients, including 1-year freedom from rejection (53.3% and 66.7% respectively, p = 0.367), 1-year patient survival (73.3% and 88.9% respectively, p = 0.197) and 1-year graft survival (66.7% and 85.2% respectively, p = 0.167). In conclusion, a VXM strategy to optimize organ allocation enables sensitized patients to successfully undergo isolated intestinal transplantation with acceptable short-term outcomes.
authors.affiliation: Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Hawksworth
authors.forename: S
authors.initials: S
authors.lastname: Rosen-Bronson
authors.forename: E
authors.initials: E
authors.lastname: Island
authors.forename: R
authors.initials: R
authors.lastname: Girlanda
authors.forename: J F
authors.initials: JF
authors.lastname: Guerra
authors.forename: C
authors.initials: C
authors.lastname: Valdiconza
authors.forename: K
authors.initials: K
authors.lastname: Kishiyama
authors.forename: K D
authors.initials: KD
authors.lastname: Christensen
authors.forename: S
authors.initials: S
authors.lastname: Kozlowski
authors.forename: S
authors.initials: S
authors.lastname: Kaufman
authors.forename: C
authors.initials: C
authors.lastname: Little
authors.forename: K
authors.initials: K
authors.lastname: Shetty
authors.forename: J
authors.initials: J
authors.lastname: Laurin
authors.forename: R
authors.initials: R
authors.lastname: Satoskar
authors.forename: B
authors.initials: B
authors.lastname: Kallakury
authors.forename: T M
authors.initials: TM
authors.lastname: Fishbein
authors.forename: C S
authors.initials: CS
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D050377:Cold Ischemia; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007118:Immunoassay; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014180:Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014850:Waiting Lists