Donor-specific antibodies (DSA) are associated with acute kidney graft rejection, but their role in small bowel/multivisceral allograft remains unclear. We carried out a prospective study to understand the impact of DSA in the setting of intestinal allograft rejection.
Thirteen patients (15 grafts) were serially evaluated for DSA levels pre- and posttransplant. DSA was determined by Luminex and the results were interpreted as fluorescence intensity (FI), with FI more than 3000 considered positive.
The clinical rejection episodes in allografts were significantly associated with the presence of DSA (P=0.041).We obtained 291 biopsy samples from graft ileum and date-matched DSA assay reports. Sixty-three (21.65%) of the biopsies showed acute rejection. The appearance of DSA were preformed (n=5, anti-human leukocyte antigen class II=3, anti-class I and II=2), de novo (n=4, 15.25±4.72 days after transplantation, anti-class II=1, and anti-class I and II=3) and never (n=6). Among the 63 biopsies, 30(47.6%) had significant correlations with positive DSA (kappa=0.30, P<0.001) and manifested severe rejection grade (P=0.009).
In this cohort of small bowel/multivisceral transplantation patients, there was a high incidence of DSA. The presence of DSA should alert the clinical team of a higher risk of rejection, and reduction of the FI is clinically associated with resolution. Serial endoscopy guided biopsies combined with simultaneous DSA measurement in postintestinal transplantation follow-up is an effective means of screening for cellular and humoral-based forms of acute rejection.
1Division of Transplantation, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
2Institute of Clinical Medicine, National Yang-Ming University and Taipei Veterans General Hospital, Taipei, Taiwan.
3Division of Liver GI Transplantation, Georgetown University Hospital, Washington, DC.
4Department of Surgery, Hospital Universitario Central de Asturias, Universidad de Oviedo, Grant Proext-MICINN A, Spain.
5Division of Transplant Surgery, University of Cincinnati, Cincinnati, OH.
This work was supported by the Division of Transplantation, Division of Nephrology and Hypertension, University of Miami School of Medicine, Transplant Foundation of South Florida; the Taipei Veterans General Hospital (VGH99E1-014, VGH99S4-001, VGH99C1-097, and VGH100B-023); and the Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
The authors declare no conflicts of interest.
6Address correspondence to: Andreas G. Tzakis, M.D., Ph.D., Division of Liver and GI Transplantation, Miller School of Medicine, University of Miami, 1801 NW 9th Ave, Miami, FL 33136.
H.T. performed clinical data collection and analysis and generated the initial and final drafts of the manuscript. I.G., J.C., and O.L. performed clinical data collection and analysis and edited the drafts of the manuscript. E.I., P.T., S.N., A.K., J.M., D.L., and D.W. performed patient care, tissue biopsy, clinical data collection, and editing the drafts of the biopsies. P.R. performed pathologic scoring on graft biopsies, antibodies assay, clinical data collection and analysis, and editing the drafts of the manuscript. E.W. and A.T. participated in research design and edited the drafts and the final version of the manuscript. All the authors have critically reviewed the manuscript.
Received 12 October 2010. Revision requested 29 October 2010.
Accepted 17 June 2011.