Simultaneous antibody-mediated rejection of multiple allografts in modified multivisceral transplantation

The patient was an 8-year-old-female with a history of intestinal pseudo-obstruction who underwent a modified multivisceral transplant (stomach, duodenum, pancreas, and small intestine). Following transplantation, she developed HLA antibody (donor-specific and non-donor-specific). Donor-specific HLA antibodies decreased 2 weeks after transplantation, but non-donor-specific HLA antibodies remained high throughout the posttransplant course. The patient experienced repeated acute rejection episodes throughout the post-transplant course, ultimately resulting in the replacement of all allografts 250 days after the initial transplantation. The explanted allografts all revealed acute vascular rejection, but at varying degrees. There was also concurrent chronic rejection, with the intestinal allograft being affected most severely. This case suggests that HLA antibodies played a critical role in antibody-mediated acute rejection and chronic rejection and that there is varying susceptibility to this form of rejection among multiple allografts.