Temporary Deceased Donor Splenic Transplant Prior to Intestinal Transplantation: A New Strategy for Desensitization?
| Autor: | Sujata Gaitonde, Ivo Tzvetanov, Pierpaolo Di Cocco, Robert J. Carroll, Enrico Benedetti, Jorge A. Almario Alvarez, Alicia B. Lichvar, Suman Setty, Mario Spaggiari |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty medicine.medical_treatment Spleen HLA Antigens Isoantibodies Intestinal failure medicine Humans Desensitization (medicine) Transplantation Deceased donor business.industry Histocompatibility Testing Incidence (epidemiology) Graft Survival Immunosuppression Kidney Transplantation Surgery medicine.anatomical_structure Parenteral nutrition business |
| Zdroj: | Transplantation Proceedings. 53:2602-2608 |
| ISSN: | 0041-1345 |
| Popis: | Intestinal transplantation is a therapeutic treatment option for patients with irreversible intestinal failure. The presence of donor-specific antibodies (DSAs) has been associated with increased antibody-mediated rejection and allograft loss for recipients of all the solid organ transplants. This case report describes the posttransplant course in the first year of a patient who received a T-cell and B-cell flow cross-match (FXM) and complement-dependent cytotoxicity cross-match positive intestinal transplant in the presence of several class I and class II DSAs who underwent a “temporary desensitization” using the donor spleen. The temporary donor splenic transplant removed several class I and II DSAs as demonstrated by the negative subsequent T-cell FXM, the decreased mean channel shift of the positive B-cell FXM with a significant decrease in DSA mean florescence intensity post temporary splenic transplant. The patient experienced an isolated incidence of acute rejection, which responded to therapy. He had no infectious or cancerous sequelae from the immunosuppression modalities. He was able to discontinue total parenteral nutrition and gained weight after the procedure. Long-term effects are not able to be determined from this approach; hence, further research is warranted to better evaluate the real efficacy of this strategy. |
| Databáze: | OpenAIRE |
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