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Severe acute cellular rejection after intestinal transplantation is associated with poor patient and graft survival
Author(s) -
Huard Genevieve,
Schiano Thomas D.,
Moon Jang,
Iyer Kishore
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12956
Subject(s) - medicine , thymoglobulin , tacrolimus , methylprednisolone , transplantation , retrospective cohort study , surgery , immunosuppression , gastroenterology
Background Severe acute cellular rejection ( ACR ) occurs frequently after intestinal transplantation ( IT x). Aim To evaluate the outcomes and the risk factors for graft failure and mortality in patients with severe ACR after IT x. Methods Retrospective study evaluating all IT x recipients who developed severe ACR between 01/2000 and 07/2014. Demographic and histologic data were reviewed. Results 20/126 (15.9%) IT x recipients developed severe ACR . Of these 20 episodes, 13 were in adults (median age: 47.1). The median ( IQR ) time from IT x to severe ACR was 206.5 (849) days. All patients received intravenous methylprednisolone and increased doses of tacrolimus. Sixteen (80%) patients did not respond to initial treatment and required thymoglobulin administration. Moreover, 11 (55%) patients required additional immunosuppressive medications. Six (30%) patients required graft enterectomy. Complications related to ACR treatment were the following: 10 (50%) patients developed bacterial infections, four (20%) patients developed cytomegalovirus infection and four (20%) patients developed post‐transplant lymphoproliferative disease. At the end of follow‐up, only 3/20 (15%) were alive with a functional allograft. The median patient survival time after diagnosis of severe ACR was 400 days (95% CI : 234.0‐2613.0). Conclusions Severe ACR episodes are associated with high rates of graft loss and complications related to treatment.