title: Successful Rescue of Late-onset Antibody-mediated Rejection 12 Years After Living-donor Intestinal Transplantation: A Case Report.
abstract: BACKGROUND
  Antibody-mediated rejection (ABMR) has recently surfaced as a potential form of graft dysfunction after intestinal transplantation.
  
  
  METHODS
  We present a case of an intestinal transplant recipient who developed late-onset ABMR 12 years after living-donor transplantation. An 18-year-old male recipient with a history of extensive intestinal resection secondary to acute bowel volvulus exhibited an excellent baseline immune profile for transplantation, including ABO-identical and HLA-haploidentical to the donor; a negative cross-match with a panel reactive antibody of 3.0%.
  
  
  RESULTS
  Post-transplantation immunosuppression consisted of tacrolimus, mycophenolate mofetil (MMF), and prednisone within the first year, followed by tacrolimus and MMF in the second year, and maintenance with tacrolimus monotherapy thereafter. The recipient experienced a single episode of indetermined acute cellular rejection 3 months after transplantation. Since then, he did not require any parenteral nutrition and had completely reintegrated with society. Twelve years later, the patient developed persistent diarrhea associated with transplant biopsy diffuse C4d deposition and circulating donor-specific antibodies. After the use of rituximab and intravenous immunoglobulin, the recipient stabilized 17 years after transplantation with complete recovery of intestinal mucosal damage.
  
  
  CONCLUSIONS
  Late-onset ABMR can emerge after transplantation and must be considered a possible cause of graft dysfunction in long-term intestinal transplantation survivors.
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China. Electronic address: guosheng_w@yahoo.com.
authors.forename: G S
authors.initials: GS
authors.lastname: Wu
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: Q C
authors.initials: QC
authors.lastname: Zhao
authors.affiliation: Department of Pathology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China.
authors.forename: Z S
authors.initials: ZS
authors.lastname: Li
authors.affiliation: Department of Clinical Pharmacology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: W Z
authors.initials: WZ
authors.lastname: Wang
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: M B
authors.initials: MB
authors.lastname: Li
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: H
authors.initials: H
authors.lastname: Shi
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: D L
authors.initials: DL
authors.lastname: Chen
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: J Y
authors.initials: JY
authors.lastname: Zheng
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China.
authors.forename: D M
authors.initials: DM
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000097:blood; D006084:Graft Rejection / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007422:Intestines / Q000637:transplantation*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D000069283:Rituximab / Q000627:therapeutic use
chemical_list: D000906:Antibodies; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab