You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Donor-specific human leukocyte antigen antibodies in intestinal transplantation

Kaneku, Hugoa; Wozniak, Laura J.b

Current Opinion in Organ Transplantation:
doi: 10.1097/MOT.0000000000000078
SMALL BOWEL TRANSPLANTATION: Edited by Douglas G. Farmer
Abstract

Purpose of review: Early outcomes following intestinal transplantation (ITx) have markedly improved in recent years. However, there has been a lack of improvement in long-term outcomes. Increasing amounts of data suggest the humoral immune system is a major contributor to rejection and late allograft loss. This review will summarize the available data on donor-specific human leukocyte antigen antibodies (DSAs) in ITx, with a focus on the clinical significance of DSAs, diagnosis of antibody-mediated rejection (AMR), and available treatment modalities. Areas requiring further investigation will also be identified.

Recent findings: Mounting evidence shows that pre- and/or posttransplant DSAs are associated with rejection and allograft loss following ITx. Preformed DSAs are present in nearly one-third of ITx recipients, and de-novo DSAs develop in up to 40% of patients. Diagnosis and treatment of AMR remains challenging, but reports indicate that when optimal induction and maintenance immunosuppressive agents are used, the impact of DSAs may be negligible.

Summary: Although data are limited due to center differences with regard to patient population, induction and maintenance immunosuppression protocols, and monitoring strategies, DSAs are associated with poor outcomes following ITx. A consensus to define AMR and optimal treatment strategies is needed.

Author Information

aDivision of Liver and Pancreas Transplantation, Department of Surgery, University of California, Los Angeles

bPediatric Gastroenterology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA

Correspondence to Hugo Kaneku, MD, Division of Liver and Pancreas Transplantation, Department of Surgery, UCLA, 610 Charles E Young Dr East, 5000D, Los Angeles, CA 90095, USA. Tel: +1 310 267 0217; e-mail: hkaneku@mednet.ucla.edu

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins