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Presenter: Jason, Hawksworth, Washington DC, United States
Authors: Jason Hawksworth1, Cal Matsumoto1, Raffaele Girlanda1, Juan Francisco Guerra1, Kimberly Christensen1, Chelsea Valdiconza1, Sandra Rosen-Bronson1, Stuart Kaufman1, Cheryl Little1, Kirti Shetty1, Jaqueline Laurin1, Rohit Satoskar1, Thomas Fishbein1
Jason Hawksworth, Cal Matsumoto, Raffaele Girlanda, Juan Francisco Guerra, Kimberly Christensen, Chelsea Valdiconza, Sandra Rosen-Bronson, Stuart Kaufman, Cheryl Little, Kirti Shetty, Jaqueline Laurin, Rohit Satoskar, Thomas Fishbein
Transplant Institute, Georgetown University Hospital, Washington, DC, United States
Given the high incidence of acute cellular rejection (ACR) following isolated intestinal transplantation (ITx), significant recipient sensitization is considered prohibitive by many centers. Virtual cross matching (VXM) may optimize organ allocation and minimize immunologic risk in sensitized recipients, enabling successful ITx transplantation.
Methods: Retrospective analysis of all isolated ITx performed in at our institution from 2003 to 2010. Allograft allocation in sensitized recipients was based on the results of a VXM in which the donor specific antibody (DSA) was evaluated. HLA antibody testing was done using a Luminex-based single-antigen assay. All potential donors were screened against recipient DSA titers. DSA titers greater than 1:16 were considered prohibitive for isolated ITx. Standard immunosuppression (IS) consisted of IL2 blockade induction with maintenance IS of tacrolimus, sirolimus, and prednisone. Sensitized recipients received thymoglobulin induction and IVIG followed by standard maintenance IS. Intestinal biopsies were obtained on protocol. Standard grading was used for histological diagnosis of ACR.
Results: 65 isolated ITx transplants were performed in 63 patients (18 pediatric and 45 adult) with a mean follow up of 37.5 months. There were 21 sensitized recipients (5 pediatric and 16 adult) with a mean PRA of 52 ±34; 5 recipients were highly sensitized with PRA >80%. Donor and recipient clinical characteristics were well matched between the sensitized and non-sensitized patients. ITx outcomes, including TPN days, 1 year freedom from rejection (FFR), 1 year survival, and incidence of PTLD were not significantly different in sensitized compared to non-sensitized patients.
Conclusions: Utilizing a VXM strategy to optimize organ allocation and immunosuppression protocols, highly sensitized adult and pediatric patients can successfully undergo isolated intestinal transplantation with comparable short term outcomes to non-sensitized recipients. Longer follow up is necessary to determine the late immunologic sequela of sensitization in isolated ITx.
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