06 February 2018 : Original article
Challenges with Intestine and Multivisceral Re-Transplantation: Importance of Timing of Re-Transplantation and Optimal ImmunosuppressionChandrashekhar A. Kubal1ACDEF*, Catherine Pennington2BCDE, Jonathan Fridell1E, Burcin Ekser1DE, Plamen Mihaylov1DE, Richard Mangus1BCDEF
Ann Transplant 2018; 23:98-104
BACKGROUND: Patients undergoing re-transplantation often receive high doses of immunosuppression, which may lead to an immunocompromised status of the recipient. This study investigates the outcomes after intestine/multivisceral re-transplantation.
MATERIAL AND METHODS: Clinical outcomes of 23 patients undergoing 24 re-transplantations at a single intestine transplant center were reviewed. Bone marrow suppression was used as a surrogate marker of immunocompromised status, and was defined as platelet count <50 k/mm3 and absolute lymphocyte count <200/mm³.
RESULTS: All re-transplants except one were liver inclusive. Fifteen of 23 patients died at a median time of 12 months (range 0.2–75) after re-transplantation. Of the 15 deaths, nine (60%) resulted from complications associated with a compromised host immune status: graft versus host disease (GVHD) affecting bone marrow (three cases), persistent viral infection (three cases), post-transplant lymphoproliferative disorder (PTLD (one case), metastatic cancer (one case), multi-drug resistant polymicrobial sepsis (one case). Four deaths (27%) resulted from severe rejection. Non-survivors were more likely to have received alemtuzumab, and had higher incidence of bone marrow suppression. In addition to immunocompromised status and rejection, the use of alemtuzumab was associated with mortality after intestinal/multivisceral re-transplantation.
CONCLUSIONS: High mortality was associated with intestine/multivisceral re-transplantation. To improve clinical outcomes of intestine and multivisceral transplantation, it is important to allow reconstitution of host immunity. Longer interval between the two transplantations, and strategies such as allograft specific immunosuppression, may spare the host from the devastating effects of potent immunosuppression currently used.
Keywords: Graft Rejection, Graft vs Host Disease, Immunocompromised Host, Intestine, Small, Transplantation
11 Jan 2022 : Original articleEfficacy of Nitric Oxide-Releasing Nanofibers in Reducing Renal Ischemia-Reperfusion Injury in a Rat Model
Ann Transplant In Press; DOI: 10.12659/AOT.934800
Most Viewed Current Articles
29 Dec 2021 : Original articleEfficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...
Ann Transplant 2021; 26:e933588
22 Dec 2021 : Original articleComparison of Coronary Artery Calcium Scoring with Dobutamine Stress Echo for Detection of Coronary Artery ...
Ann Transplant 2021; 26:e934163
01 Dec 2021 : Original articleSolid-Phase C1q/C3d Fixing Readouts Correlate with High Median Fluorescence Intensity (MFI) De Novo Donor-S...
Ann Transplant 2021; 26:e934175