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- W2775353350 abstract "AIM: We designed and utilized a protocol for immunosuppression for intestine transplantation across positive crossmatch with evidence of class I and/or class II donor specific antibodies (DSA). Patients were evaluated for rejection and infection events with comparison to procedure matched controls on standard protocol of immunosuppression. METHODS: We utilize a protocol for intestine and multivisceral transplantation for patients with high panel reactive antibodies (PRA) or a positive flow crossmatch. We added to our standard protocol consisting of tacrolimus at goal trough 15-20ng/mL, solumedrol taper, thymoglobulin at 2mg/kg on post operative day (POD) 0, 2 and 4, and basiliximab 20mg once monthly beginning POD 14. Patients with positive prospective or retrospective crossmatch were additionally given rituximab 150mg/m2 beginning 4 hours preoperatively and intravenous immunoglobulin (IVIg) 1 gram/kg. DSA was sent for clinical evaluation on monthly intervals. Patients were screened for rejection by endoscopic evaluation and biopsy of small intestine on a routine basis. RESULTS: Four patients were transplanted in 2013 across positive T and B cell flow crossmatch. Two received isolated intestine transplants (IT) and two had multivisceral transplantation (MVT). During a six month follow-up, none of the patients had episodes of rejection or cytomegalovirus (CMV) infection. One patient developed major infection and two developed minor infections. All four patients saw a significant decrease in their pre-existing DSA titers using this regimen. Among procedure-matched controls with negative final crossmatch on standard management (no preoperative rituximab or IVIg), two developed mild acute cellular rejection and two developed minor infections. CONCLUSIONS: We report our protocol for immunosuppression for IT and MVT across a positive crossmatch. This allowed for transplant despite the presence of positive crossmatch and significant class I and/or II DSA with lower rejection rates but potentially increased risk for major infections compared to controls." @default.
- W2775353350 created "2017-12-22" @default.
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- W2775353350 date "2014-07-01" @default.
- W2775353350 modified "2023-10-16" @default.
- W2775353350 title "Protocol for Intestine Transplantation Across Positive Crossmatch With Preformed Donor Specific Antibodies - A Single Center Experience." @default.
- W2775353350 doi "https://doi.org/10.1097/00007890-201407151-02963" @default.
- W2775353350 hasPublicationYear "2014" @default.
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