Impacts of donor-specific anti-HLA antibodies and antibody-mediated rejection on outcomes after intestinal transplantation in children

Autor: C Suberbielle-Boissel, Danielle Canioni, Marion Rabant, Laëtitia Marie Petit, Christophe Chardot, Olivier Goulet, Florence Lacaille
Rok vydání: 2017
Předmět:
Graft Rejection
Male
Antilymphocyte Serum/therapeutic use
Humanized/therapeutic use
medicine.medical_treatment
030230 surgery
Gastroenterology
Bortezomib
Cohort Studies
0302 clinical medicine
HLA Antigens
Isoantibodies
Monoclonal
Medicine
Child
ddc:618
Graft Survival
Immunoglobulins
Intravenous
Immunosuppression
Plasmapheresis
Eculizumab
Prognosis
Tissue Donors
Intestines/transplantation
Intestines
Treatment Outcome
Child
Preschool
Antibody mediated rejection
Bortezomib/therapeutic use
Female
Steroids
030211 gastroenterology & hepatology
Rituximab
HLA Antigens/immunology
Intravenous/therapeutic use
Peptide Fragments/immunology
medicine.drug
medicine.medical_specialty
Isoantibodies/immunology
Adolescent
Immunoglobulins
Antibodies
Monoclonal
Humanized
Steroids/therapeutic use
Antibodies
03 medical and health sciences
Internal medicine
Rituximab/therapeutic use
Complement C4b
Humans
Antibodies/immunology
Risk factor
Preschool
Antilymphocyte Serum
Immunosuppression Therapy
Transplantation
business.industry
Infant
Complement C4b/immunology
Graft Rejection/immunology
Peptide Fragments
Pediatrics
Perinatology and Child Health
business
Zdroj: Pediatric Transplantation, Vol. 21, No 2 (2017)
ISSN: 1397-3142
DOI: 10.1111/petr.12847
Popis: AMR is a risk factor for graft failure after SBTx. We studied impact of DSAs and AMR in 22 children transplanted between 2008 and 2012 (11 isolated SBTx, 10 liver inclusive Tx, and one modified multivisceral Tx). Three patients never developed DSA, but DSAs were found in seven in the pre-Tx period and de novo post-Tx in 19 children. Pathology revealed cellular rejection (15/19), with vascular changes and C4d+. Patients were treated with IV immunoglobulins, plasmapheresis, and steroids. Rescue therapy included antithymocyte globulins, rituximab, eculizumab, and bortezomib. Pathology and graft function normalized in 13 patients, graft loss occurred in two, and death in seven. At the end of the follow-up, 15 children were alive (68%), 13 with functioning graft (59%). Prognosis factors for poor outcome after Tx were the presence of symptoms at AMR suspicion (P +.033). DSAs were often found following SBTx, mostly de novo. Resistant ACR or severe AMR is still difficult to differentiate, with a high need for immunosuppression in both. DSAs may precede development of severe disease and pathology features on the graft: relationship and correlation need to be better investigated with larger groups before and after Tx.
Databáze: OpenAIRE
Externí odkaz: