Successful combined auxiliary partial liver and intestinal transplantation in two highly sensitized, cross-match positive patients
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd..
INTRODUCTION: Sensitization to human leukocyte antigen (HLA) creates an immunological barrier to intestinal transplantation (ITx). Current desensitization therapies are limited and ineffective in the most highly sensitized patients. A co-transplanted whole liver transplant can protect a kidney, heart, or intestinal allograft from antibody-mediated injury. Whether an auxiliary partial liver allograft provides effective protection for highly sensitized intestinal transplant recipients is unknown.
METHODS: Two patients with strong HLA donor-specific antibody at high titer against their deceased donors underwent combined auxiliary partial liver and ITx across a positive cross-match. The left lateral lobes from the combined-graft recipients and the right liver lobes from the deceased donors were transplanted as a domino procedure to other four patients.
RESULTS: Two combined-graft recipients have had an uneventful postoperative course without major complications at a 12- and 24-month follow-up, respectively. Intestinal graft function has been excellent with no evidence of humoral or cellular rejection. While a positive cross-match turned negative, titers of donor-specific HLA antibodies gradually declined over time after transplant. The left liver lobes procured from the combined-graft recipients were successfully transplanted into two pediatric patients (age 1.9, 2.4 years) and the right lobes from two deceased donors were successfully transplanted into two adult patients. All transplant procedures went well, without post-operative complications related to the splitting technique.
CONCLUSION: Our results indicate that an auxiliary liver transplant can effectively protect a co-transplanted intestinal allograft against rejection and suggest that this combined procedure may serve as a useful therapeutic adjunct for a highly sensitized intestinal transplant candidate.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
|---|---|
| Enthalten in: |
Clinical transplantation - 37(2023), 3 vom: 13. März, Seite e14865 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Wu, Guosheng [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Antibodies |
|---|
| Anmerkungen: |
Date Completed 14.03.2023 Date Revised 18.03.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/ctr.14865 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM349294100 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM349294100 | ||
| 003 | DE-627 | ||
| 005 | 20231226042259.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/ctr.14865 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1164.xml |
| 035 | |a (DE-627)NLM349294100 | ||
| 035 | |a (NLM)36416299 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Wu, Guosheng |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Successful combined auxiliary partial liver and intestinal transplantation in two highly sensitized, cross-match positive patients |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 14.03.2023 | ||
| 500 | |a Date Revised 18.03.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. | ||
| 520 | |a INTRODUCTION: Sensitization to human leukocyte antigen (HLA) creates an immunological barrier to intestinal transplantation (ITx). Current desensitization therapies are limited and ineffective in the most highly sensitized patients. A co-transplanted whole liver transplant can protect a kidney, heart, or intestinal allograft from antibody-mediated injury. Whether an auxiliary partial liver allograft provides effective protection for highly sensitized intestinal transplant recipients is unknown | ||
| 520 | |a METHODS: Two patients with strong HLA donor-specific antibody at high titer against their deceased donors underwent combined auxiliary partial liver and ITx across a positive cross-match. The left lateral lobes from the combined-graft recipients and the right liver lobes from the deceased donors were transplanted as a domino procedure to other four patients | ||
| 520 | |a RESULTS: Two combined-graft recipients have had an uneventful postoperative course without major complications at a 12- and 24-month follow-up, respectively. Intestinal graft function has been excellent with no evidence of humoral or cellular rejection. While a positive cross-match turned negative, titers of donor-specific HLA antibodies gradually declined over time after transplant. The left liver lobes procured from the combined-graft recipients were successfully transplanted into two pediatric patients (age 1.9, 2.4 years) and the right lobes from two deceased donors were successfully transplanted into two adult patients. All transplant procedures went well, without post-operative complications related to the splitting technique | ||
| 520 | |a CONCLUSION: Our results indicate that an auxiliary liver transplant can effectively protect a co-transplanted intestinal allograft against rejection and suggest that this combined procedure may serve as a useful therapeutic adjunct for a highly sensitized intestinal transplant candidate | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a auxiliary partial liver transplantation | |
| 650 | 4 | |a intestinal transplantation | |
| 650 | 4 | |a positive cross-match | |
| 650 | 4 | |a sensitization | |
| 650 | 7 | |a Antibodies |2 NLM | |
| 700 | 1 | |a Liu, Chaoxu |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Nan |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, Xile |e verfasserin |4 aut | |
| 700 | 1 | |a Zhao, Long |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Yuntao |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Wentong |e verfasserin |4 aut | |
| 700 | 1 | |a Liang, Tingbo |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Clinical transplantation |d 1987 |g 37(2023), 3 vom: 13. März, Seite e14865 |w (DE-627)NLM07493306X |x 1399-0012 |7 nnns |
| 773 | 1 | 8 | |g volume:37 |g year:2023 |g number:3 |g day:13 |g month:03 |g pages:e14865 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/ctr.14865 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 37 |j 2023 |e 3 |b 13 |c 03 |h e14865 | ||