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Impacts of donor‐specific anti‐HLA antibodies and antibody‐mediated rejection on outcomes after intestinal transplantation in children
Author(s) -
Petit L.M.,
Rabant M.,
Canioni D.,
SuberbielleBoissel C.,
Goulet O.,
Chardot C.,
Lacaille F.
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12847
Subject(s) - medicine , plasmapheresis , rituximab , eculizumab , immunosuppression , bortezomib , antibody , donor specific antibodies , transplantation , gastroenterology , immunology , surgery , multiple myeloma , complement system , kidney transplantation
AMR is a risk factor for graft failure after SBT x. We studied impact of DSA s and AMR in 22 children transplanted between 2008 and 2012 (11 isolated SBT x, 10 liver inclusive Tx, and one modified multivisceral Tx). Three patients never developed DSA , but DSA s were found in seven in the pre‐Tx period and de novo post‐Tx in 19 children. Pathology revealed cellular rejection (15/19), with vascular changes and C4d+. Patients were treated with IV immunoglobulins, plasmapheresis, and steroids. Rescue therapy included antithymocyte globulins, rituximab, eculizumab, and bortezomib. Pathology and graft function normalized in 13 patients, graft loss occurred in two, and death in seven. At the end of the follow‐up, 15 children were alive (68%), 13 with functioning graft (59%). Prognosis factors for poor outcome after Tx were the presence of symptoms at AMR suspicion ( P +.033). DSA s were often found following SBT x, mostly de novo. Resistant ACR or severe AMR is still difficult to differentiate, with a high need for immunosuppression in both. DSA s may precede development of severe disease and pathology features on the graft: relationship and correlation need to be better investigated with larger groups before and after Tx.