Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISBTS 2013 Symposium


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Oral Communications 2

8.221 - Human Leukocyte Antigen (HLA) antibody monitoring following adult modified multivisceral transplant

Presenter: Mian, Chen, , United Kingdom
Authors: Mian Chen1, Helenna Lythgoe1, Suzanne Page1, Jeanette Procter1, Martin Barnardo1, Georgios Vrakas1, Srikanth Reddy1, Peter Friend1, Anil Vaidya1, Susan Fuggle1

Human Leukocyte Antigen (HLA) antibody monitoring following adult modified multivisceral transplant

Mian Chen1, Helenna Lythgoe1, Suzanne Page1, Jeanette Procter1, Martin Barnardo1, Georgios Vrakas1, Srikanth Reddy1, Peter Friend1, Anil Vaidya1, Susan Fuggle1

1Oxford Transplant Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom

The development of donor specific HLA antibodies following transplantation is associated with poorer outcome in many transplant modalities.  The aim of this study was to assess the impact of early post-transplant HLA DSA in the adult modified multivisceral (MMV) transplant recipient.
 
HLA antibody monitoring was available for 15 of 16 patients transplanted between 2008 and 2012 with small bowel alone or in combination with stomach, pancreas, kidney and/or abdominal wall.  All patients were screened for HLA antibodies pre-transplant using Luminex technology and HLA antibodies specified using PRA or Single Antigen beads.  Defined donor-specific HLA specificities were considered a contraindication to transplant.  Pre-transplant crossmatching was performed by complement dependent cytotoxicity (CDC) and by flow cytometry (FC).  All CDC crossmatches and 13/15 FC were IgG negative, the remaining 2 were borderline FC positive, but no pre-existing DSA had been detected by Luminex antibody screening.
 
HLA antibody monitoring was performed at 4-8 weeks post transplant.  In 5/15 (33%) recipients the post-transplant HLA antibody status remained unchanged, but 10/15 (67%) recipients became sensitised to HLA following transplant and in 6/10 (60%) the antibodies were donor specific.  There was no association between donor mismatches, peri-operative transfusion or recipient gender and either post-transplant sensitisation or development of DSA.  3/4 recipients who experienced rejection developed HLA DSA within the first two months post-transplant. In recipients with DSA, rejection was moderate to severe indicating that reduction or changes to immunosuppression in such patients should be done with caution.
 
These results demonstrate that a high proportion of MMV transplant recipients become sensitised against HLA in the early post-operative period.  This may be due to the highly alloimmunogenic nature of the graft and/or the prevalence of peri-operative transfusion.  Furthermore, the presence of early HLA DSA may predict the development of rejection and their timely characterisation may provide information useful in the clinical management of these complex patients.


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