title: Impact of positive flow cytometry crossmatch on outcomes of intestinal/multivisceral transplantation: role anti-IL-2 receptor antibody.
abstract: BACKGROUND
  Positive crossmatch may be associated with an increased risk of acute rejection (AR) and worse overall outcomes after intestinal/multivisceral (MV) transplantation. However, the evidence from published studies in this setting is sparse and contradictory. This study reports the impact of positive flow cytometry crossmatch on clinical outcomes after intestinal/MV transplantation and the use of anti-interleukin (IL)-2 receptor antibody as a maintenance immunosuppressant.
  
  
  METHODS
  Records of all intestinal/MV transplants from 2003 to 2010 were reviewed. Flow cytometry was used to evaluate T- and B-cell crossmatch status. Standard immunosuppression included rabbit anti-thymocyte globulin-rituximab induction with tacrolimus and steroid maintenance. From 2008 onwards (second era), monthly anti-IL-2 receptor antibody was added to the maintenance immunosuppression in patients receiving liver-excluding transplants.
  
  
  RESULTS
  Of 131 intestinal/MV transplants, 27 (21%) had a positive crossmatch. Positive crossmatch was not associated with an increased incidence of AR and graft loss (30% and 37% vs. 29% and 47%; P=0.94 and 0.35, respectively). This effect was maintained in liver-excluding transplants. Overall rate of AR decreased from 39% to 22% in the second era. In liver-excluding transplants, there was a significant decrease in AR from 75% to 44% with the use of anti-IL-2 receptor antibody therapy.
  
  
  CONCLUSIONS
  With rabbit anti-thymocyte globulin-rituximab induction, positive crossmatch status is not associated with worse outcomes after intestinal/MV transplantation. Use of anti-IL-2 receptor antibody as a part of maintenance immunosuppression may be beneficial in liver-excluding transplants.
authors: Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202-5250, USA. sakubal@iupui.edu
authors: Chandrashekhar A
authors: CA
authors: Kubal
authors: Richard S
authors: RS
authors: Mangus
authors: Rodrigo M
authors: RM
authors: Vianna
authors: Andrew
authors: A
authors: Lobashevsky
authors: Mohammad A
authors: MA
authors: Mujtaba
authors: Nancy
authors: N
authors: Higgins
authors: Thiago
authors: T
authors: Beduschi
authors: Jonathan A
authors: JA
authors: Fridell
authors: A Joseph
authors: AJ
authors: Tector
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D008297:Male; D015375:Receptors, Interleukin-2 / Q000276:immunology*
chemical_list: D000906:Antibodies; D015375:Receptors, Interleukin-2