title: Abdominal Wall Transplantation: Skin as a Sentinel Marker for Rejection.
abstract: Abdominal wall transplantation (AWTX) has revolutionized difficult abdominal closure after intestinal transplantation (ITX). More important, the skin of the transplanted abdominal wall (AW) may serve as an immunological tool for differential diagnosis of bowel dysfunction after transplant. Between August 2008 and October 2014, 29 small bowel transplantations were performed in 28 patients (16 male, 12 female; aged 41 ± 13 years). Two groups were identified: the solid organ transplant (SOT) group (n = 15; 12 ITX and 3 modified multivisceral transplantation [MMVTX]) and the SOT-AWTX group (n = 14; 12 ITX and 2 MMVTX), with the latter including one ITX-AWTX retransplantation. Two doses of alemtuzumab were used for induction (30 mg, 6 and 24 h after reperfusion), and tacrolimus (trough levels 8-12 ng/mL) was used for maintenance immunosuppression. Patient survival was similar in both groups (67% vs. 61%); however, the SOT-AWTX group showed faster posttransplant recovery, better intestinal graft survival (79% vs. 60%), a lower intestinal rejection rate (7% vs. 27%) and a lower rate of misdiagnoses in which viral infection was mistaken and treated as rejection (14% vs. 33%). The skin component of the AW may serve as an immune modulator and sentinel marker for immunological activity in the host. This can be a vital tool for timely prevention of intestinal graft rejection and, more important, avoidance of overimmunosuppression in cases of bowel dysfunction not related to graft rejection.
authors.affiliation: Department of Transplant Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.|Department of General, Visceral and Transplantation Surgery, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: U A
authors.initials: UA
authors.lastname: Gerlach
authors.affiliation: Department of Transplant Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.
authors.forename: G
authors.initials: G
authors.lastname: Vrakas
authors.affiliation: Institute for Medical Immunology, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Sawitzki
authors.affiliation: Department of Transplant Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Macedo
authors.affiliation: Department of Transplant Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Transplant Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Friend
authors.affiliation: Department of Plastic and Reconstructive Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.
authors.forename: H
authors.initials: H
authors.lastname: Giele
authors.affiliation: Department of Transplant Surgery, Oxford University Hospitals and University of Oxford, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Vaidya
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000601:surgery*; D012871:Skin Diseases / Q000209:etiology / Q000473:pathology*; D016896:Treatment Outcome