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Presenter: Selcuk, Kilinc, ISTANBUL, Turkey
Authors: Selcuk Kilinc1
Selcuk Kilinc
Tepecik Training and Research Hospital, Izmir, Turkey
Introduction: Acute cellular rejection (ACR) occurs more frequently and severely in the small intestinal graft than in any other abdominal organ. (1)MSCs are able to inhibit T cell proliferation in vitro and in vivo and exert similar inhibitory effects on B, dendritic, and natural killer cells as a new stem cell therapy class for autoimmune disease, solid organ transplantation and treatment of graft-versus-host disease (GVHD). (2,3,4) Severe liver dysfunction and fibrosis is another problem. MSCs can produce a series of growth factors, enhance hepatocyte functionality and stimulate endogenous hepatocyte proliferation .(5,6)
Aim: We describe three patients with intestinal failure treated by small bowel (SB) tx and MCSs andanalyze these patients’ prognosis and follow-up.
Ethics committee: Republic of Turkey Ministry of Health permission granted.
Discussion: Property and treatment modality of cases seen in table.
The aim in all cases was for a first dose of at least 1 million/kg to be given from the transplanted organ SMA, and for a second dose to be given by catheter inserted 15 days postoperatively. The absence of rejection in Case 2 may be attributed to the different method of administration.This could not be done in two cases that died for various reasons as detailed respectively: Incompatibilities between suitable cadaver donor harvesting time and MSCs of adequate maturity being obtained ; inability to take samples containing sufficient qualification from bone marrow as a result of clinical failures in the patient due to undergo small bowel transfer ;inability to administer first dose of MSCs on day 0 postoperatively due to incompatibility in cadaveric donor and recipient blood crosses.
So we newly designed phase 2 clinical study (30 cases) and the requisite permissions have been obtained.
Table: Immunosupressive treatment and property of cases
|
Age/ Gender |
Diagnosis |
HLA |
Donor HLA |
Tx time |
Donor |
MSCs |
IR |
ACR time |
Follow-up |
Case 1 |
25/F |
Total intestinal resection due to mesenteric artery ischemia in gestation (8 week) |
A 02/24 B 59 DR 02/30 |
A02/30 B3/58 DR03/07 |
1 yr after resection |
Cadaveric SBTx |
1st dose: 1x106 per kg by subclavian vein , 1 week before SBTx 2nd: dose 2 weeks after SBTx by same dose via intra venous route |
ATG Steroid, FK 506, |
13 days later, severe |
Ex 18th day ( severe rejection,sepsis) |
Case 2 |
12/F |
Total intestinal resection due to mesenteric artery trauma |
A 02/24 B 08/51 DRB1 3/13 |
A 02/24 B12/44 DB 1 3
|
1 yr later |
Cadaveric SBTx |
2 doses: 1st dose: 1x106 per kg via superior mesenteric artery catheter at time of operation 2nd: same dose by intra venous route |
ATG Steroid, FK 506, Sirolimus, |
1 mo later mildly |
Lived (1 yr) TPN deseaced at 3th mo |
Case 3 |
45/ M |
Total intestinal resection and hemi-colectomia due to mesenteric arter ischemia |
A26 B 08 DRB1 /04 |
A02/02 B40/51 DR03/15 |
1 month after resection |
Cadaveric SBTx |
1st dose 0,5x106 per kg via portal vein 1 day before SBTx 2nd dose: Can’t administration |
ATG Steroid, FK 506, |
Severe, 2 mo later |
Ex, at 67 days (severe rejection,sepsis) |
IR:Immunosuppressive regimen, ATG: Anti thymocyte globulin, TPN: Total parenteral nutrition
Literature:
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