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Abdominal Wall Transplantation: Skin as a Sentinel Marker for Rejection.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2016 Jun; Vol. 16 (6), pp. 1892-900. Date of Electronic Publication: 2016 Feb 25. - Publication Year :
- 2016
-
Abstract
- Abdominal wall transplantation (AWTX) has revolutionized difficult abdominal closure after intestinal transplantation (ITX). More important, the skin of the transplanted abdominal wall (AW) may serve as an immunological tool for differential diagnosis of bowel dysfunction after transplant. Between August 2008 and October 2014, 29 small bowel transplantations were performed in 28 patients (16 male, 12 female; aged 41 ± 13 years). Two groups were identified: the solid organ transplant (SOT) group (n = 15; 12 ITX and 3 modified multivisceral transplantation [MMVTX]) and the SOT-AWTX group (n = 14; 12 ITX and 2 MMVTX), with the latter including one ITX-AWTX retransplantation. Two doses of alemtuzumab were used for induction (30 mg, 6 and 24 h after reperfusion), and tacrolimus (trough levels 8-12 ng/mL) was used for maintenance immunosuppression. Patient survival was similar in both groups (67% vs. 61%); however, the SOT-AWTX group showed faster posttransplant recovery, better intestinal graft survival (79% vs. 60%), a lower intestinal rejection rate (7% vs. 27%) and a lower rate of misdiagnoses in which viral infection was mistaken and treated as rejection (14% vs. 33%). The skin component of the AW may serve as an immune modulator and sentinel marker for immunological activity in the host. This can be a vital tool for timely prevention of intestinal graft rejection and, more important, avoidance of overimmunosuppression in cases of bowel dysfunction not related to graft rejection.<br /> (© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Adult
Female
Graft Rejection etiology
Graft Survival
Humans
Male
Prospective Studies
Short Bowel Syndrome complications
Skin Diseases etiology
Treatment Outcome
Abdominal Wall surgery
Graft Rejection diagnosis
Intestines transplantation
Postoperative Complications
Short Bowel Syndrome surgery
Skin Diseases pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 16
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 26713513
- Full Text :
- https://doi.org/10.1111/ajt.13693