title: Successful ABO-incompatible living-related intestinal transplantation: a 2-year follow-up.
abstract: ABO-incompatible intestinal transplantation has rarely been performed due to poor patient outcomes. Herein we present a case of successful ABO-incompatible intestinal transplantation with a 2-year follow-up. A 16-year-old female with a history of extensive bowel resection received an ABO-incompatible living donor bowel graft from her father (blood type AB graft into a type A recipient). Posttransplant immunosuppression consisted of an initial anti-CD20, plasmapheresis/intravenous immunoglobulin before transplantation, followed by an anti-thymocyte globulin (ATG) induction and splenectomy, and maintenance with tacrolimus and prednisone. Her postoperative course was remarkable for a single episode of rejection on day 14 which responded promptly to treatment with methyprednisolone and ATG. Three months after transplantation, the patient developed an abdominal abscess requiring open surgical drainage. No viral infections were encountered. Posttransplant anti-B antibody titers and anti-B7 donor-specific antibody levels remained low. At a 2-year follow-up, the patient showed a progressive weight gain of 5.0 kg. This case illustrates that ABO-incompatible living-related bowel transplantation is immunologically feasible and is associated with good outcomes for the recipient. The management of blood type antibodies and the use of adequate immunosuppression in the early period of the procedure may be the keys to the success of future cases.
authors: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors: D M
authors: DM
authors: Fan
authors: Q C
authors: QC
authors: Zhao
authors: W Z
authors: WZ
authors: Wang
authors: H
authors: H
authors: Shi
authors: M
authors: M
authors: Wang
authors: D L
authors: DL
authors: Chen
authors: J Y
authors: JY
authors: Zheng
authors: M B
authors: MB
authors: Li
authors: G S
authors: GS
authors: Wu
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D018941:Antigens, CD19 / Q000378:metabolism; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001787:Blood Group Incompatibility / Q000276:immunology; D005220:Fathers; D005260:Female; D005500:Follow-Up Studies; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007422:Intestines / Q000637:transplantation*; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage; D014180:Transplantation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D018941:Antigens, CD19; D000961:Antilymphocyte Serum; D011241:Prednisone; D016559:Tacrolimus; D008775:Methylprednisolone
keywords: ABO incompatibility; clinical research / practice; immunosuppressive regimens; intestinal (allograft) function / dysfunction; intestine / multivisceral transplantation