Intestine Transplantation Across a Positive Crossmatch With Preformed Donor-Specific Antibodies

Area of Science:

• Transplantation immunology
• Surgical innovation

Background:

• Positive crossmatch historically limits organ transplantation.
• Developing effective immunosuppression protocols is crucial for overcoming immunological barriers.

Purpose of the Study:

• To evaluate a modified immunosuppression protocol for intestine transplantation (IT) and multivisceral transplantation (MVT) in patients with positive crossmatches.
• To assess rejection and infectious complications in this patient cohort.

Main Methods:

• A modified immunosuppression protocol involving rituximab and intravenous immunoglobulin (IVIg) preoperatively was used for positive crossmatch cases.
• Patients were monitored for rejection via endoscopic evaluation and donor-specific antibody (DSA) testing.
• Outcomes were compared to procedure-matched controls on standard immunosuppression with negative crossmatches.

Main Results:

• Four patients underwent IT/MVT with positive crossmatches; one experienced severe acute cellular rejection, managed with increased immunosuppression.
• No cytomegalovirus (CMV) infections occurred in the modified protocol group.
• One major and three minor bacterial infections were observed; controls had milder rejection and infections, but one CMV viremia.

Conclusions:

• The modified immunosuppression protocol facilitates IT and MVT across positive crossmatches.
• This strategy achieves low rejection rates but may increase the risk of major infections compared to standard protocols in negative crossmatch recipients.