Immediate Antibody-Mediated (Hyperacute) Rejection in Small-Bowel Transplantation and Relationship to Cross-Match Status and Donor-Specific C4d-Binding Antibodies: Case Report
| Autor: | Jang Moon, G. Selvaggi, Panagiotis Tryphonopoulos, Deborah Weppler, Andreas G. Tzakis, Eddie Island, Seigo Nishida, Philip Ruiz, David Levi, Manuel Carreno, Christopher M. Gomez, Akin Tekin |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Reoperation Short Bowel Syndrome medicine.medical_specialty Pathology medicine.medical_treatment Gastroenterology Serology Postoperative Complications Crohn Disease Antigen Isoantibodies Internal medicine Biopsy Complement C4b medicine Humans Intestinal Mucosa HLA-D Antigens Transplantation biology medicine.diagnostic_test business.industry Histocompatibility Antigens Class I Immunosuppression Peptide Fragments Histocompatibility Intestines biology.protein Female Parenteral Nutrition Total Surgery Plasmapheresis Antibody business |
| Zdroj: | Transplantation Proceedings. 42:95-99 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2009.12.025 |
| Popis: | Background The role of preformed donor-specific antibodies (DSAs) as a barrier to isolated intestinal transplantation (ITx) remains ambiguous; thus, a positive cross-match has not been a contraindication to ITx. Objective To report the case of a patient with Crohn's disease who underwent ITx and developed immediate antibody-mediated rejection on reperfusion of the allograft. Methods Percent reactive antibody testing was performed using pretransplantation serum samples and at transplantation using bead-based assays (Luminex, Luminex Corp, Austin, Tex) and flow cytometry solid-phase assays (FlowPRA single-antigen beads (One Lambda, Inc, Canoga Park, Calif). Serologic tests, flow cytometry cross-matching, and flow cytometry assays of C4d-binding serum antibodies were also performed. Histologic and immunofluorescent analysis of biopsy specimens was performed. Results HLA typing revealed no sharing of class I or II antigens between donor and recipient. Pretransplantation donor-specific antibodies (DSA) were present at transplantation. Cross-matching (performed during surgery) was positive for class I and II by serologic testing and flow cytometry. After reperfusion, the graft immediately developed severe ischemic injury and arteritis on mucosal biopsy specimens, with immunoglobulin deposition. The DSA C4d binding antibodies were also present. After intense immunosuppression and plasmapheresis, the graft and the biopsy histologic findings showed marked improvement (day 2). By day 7 posttransplantation, patient and graft status were stable. The patient has remained clinically stable for more than a year after transplantation. Conclusions Pretransplant DSA in ITx can be a risk factor for immediate (hyperacute) but potentially reversible antibody-mediated rejection. Thus, pretransplantation DSA and cross-match results are critical components to be considered in patients awaiting or undergoing ITx. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect