Open AccessDe novo donor‐specific HLA antibodies after combined intestinal and vascularized composite allotransplantation — a retrospective study
Author(s) -
Weissenbacher Annemarie,
Vrakas Georgios,
Chen Mian,
Reddy Srikanth,
Allan Philip,
Giele Henk,
Barnardo Martin C.N.M,
Vaidya Anil,
Friend Peter J.,
Fuggle Susan V.
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13096
Subject(s) - medicine , donor specific antibodies , allotransplantation , gastroenterology , incidence (geometry) , transplantation , isoantibodies , antibody , human leukocyte antigen , surgery , kidney transplantation , immunology , antigen , physics , optics
Summary Combining vascularized composite allotransplantation ( VCA ) with intestinal transplantation to achieve primary abdominal closure has become a feasible procedure. Besides facilitating closure, the abdominal wall can be used to monitor intestinal rejection. As the inclusion of a VCA raises the possibility of an enhanced alloimmune response, we investigated the incidence and clinical effect of de novo donor‐specific HLA antibodies (dn DSA ) in a cohort of patients receiving an intestinal transplant with or without a VCA . The sequential clinical study includes 32 recipients of deceased donor intestinal and VCA transplants performed between 2008 and 2015; eight (25%) modified multivisceral transplants and 24 (75%) isolated small bowel transplants. A VCA was used in 18 (56.3%) cases. There were no episodes of intestinal rejection without VCA rejection. Fourteen patients (14 of 29; 48.3%) developed dn DSA . In the VCA group, fewer patients developed dn DSA ; six of 16 (37.5%) VCA vs. eight of 13 (61.5%) non‐ VCA . There was no statistically significant difference in one‐ and 3‐year overall graft survival stratified for the presence of dn DSA ; P = 0.286. In the study, there is no evidence that the addition of a VCA increases the incidence of dn DSA formation compared to transplantation of the intestine alone.