Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies.
BACKGROUND
We describe our experience using a modified protocol for immunosuppression for intestine transplantation across a positive crossmatch. Patients who underwent transplantation in 2013 were evaluated over a 12-month period for rejection and infectious events with comparison to procedure-matched controls on our standard protocol of immunosuppression.


METHODS
We used a modified protocol for intestine and multivisceral transplantation for patients with a positive flow crossmatch. In addition to our standard protocol, patients with positive crossmatch were given rituximab and intravenous immunoglobulin (IVIg) preoperatively. DSA was sent for clinical evaluation at monthly intervals. Patients were screened for rejection by endoscopic evaluation.


RESULTS
Four patients underwent transplantation within a single year across a positive crossmatch. Two received isolated intestine transplants and 2 had multivisceral transplantation (MVT). During the 12-month follow-up, 1 patients had an episode of severe acute cellular rejection, which was managed with increased immunosuppression. None of the patients had episodes of cytomegalovirus infection. One patient developed major infection and 3 patients developed minor bacterial infections. Among procedure-matched controls with negative final crossmatch on standard management (no preoperative rituximab or IVIg), 2 developed mild acute cellular rejection and 2 developed minor infections. One developed cytomegalovirus viremia with invasion to the colonic mucosa.


CONCLUSIONS
We report our protocol for immunosuppression for IT and MVT across a positive crossmatch. This allowed transplantation despite the presence of a positive crossmatch, with low rejection rates but potentially increased risk for major infections compared to the negative crossmatch controls on our standard protocol.
Department of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan.
R
R
Parekh
Department of Transplant Surgery, Henry Ford Hospital, Detroit, Michigan.
M
M
Kazimi
Department of Pathology, Henry Ford Hospital, Detroit, Michigan.
S
S
Skorupski
Department of Pathology, Henry Ford Hospital, Detroit, Michigan.
O
O
Fagoaga
Department of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan.
S
S
Jafri
Department of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan. Electronic address: msegovi3@hfhs.org.
M C
MC
Segovia
D000328:Adult; D005260:Female; D005767:Gastrointestinal Diseases / Q000276:immunology / Q000601:surgery*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous