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Impacts of donor-specific anti-HLA antibodies and antibody-mediated rejection on outcomes after intestinal transplantation in children.
- Source :
-
Pediatric transplantation [Pediatr Transplant] 2017 Mar; Vol. 21 (2). Date of Electronic Publication: 2017 Jan 13. - Publication Year :
- 2017
-
Abstract
- AMR is a risk factor for graft failure after SBTx. We studied impact of DSAs and AMR in 22 children transplanted between 2008 and 2012 (11 isolated SBTx, 10 liver inclusive Tx, and one modified multivisceral Tx). Three patients never developed DSA, but DSAs 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). DSAs were often found following SBTx, mostly de novo. Resistant ACR or severe AMR is still difficult to differentiate, with a high need for immunosuppression in both. DSAs 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.<br /> (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adolescent
Antibodies, Monoclonal, Humanized therapeutic use
Antilymphocyte Serum therapeutic use
Bortezomib therapeutic use
Child
Child, Preschool
Cohort Studies
Complement C4b immunology
Female
Graft Survival
Humans
Immunoglobulins, Intravenous therapeutic use
Immunosuppression Therapy
Infant
Isoantibodies immunology
Male
Peptide Fragments immunology
Plasmapheresis
Prognosis
Rituximab therapeutic use
Steroids therapeutic use
Tissue Donors
Treatment Outcome
Antibodies immunology
Graft Rejection immunology
HLA Antigens immunology
Intestines transplantation
Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1399-3046
- Volume :
- 21
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Pediatric transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 28084679
- Full Text :
- https://doi.org/10.1111/petr.12847