Successful isolated intestinal transplantation in sensitized recipients with the use of virtual crossmatching

J. S. Hawksworth, S. Rosen-Bronson, E. Island, R. Girlanda, J. F. Guerra, C. Valdiconza, K. Kishiyama, K. D. Christensen, S. Kozlowski, S. Kaufman, C. Little, K. Shetty, J. Laurin, R. Satoskar, B. Kallakury, T. M. Fishbein, C. S. Matsumoto*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

We evaluated virtual crossmatching (VXM) for organ allocation and immunologic risk reduction in sensitized isolated intestinal transplantation recipients. All isolated intestine transplants performed at our institution from 2008 to 2011 were included in this study. Allograft allocation in sensitized recipients was based on the results of a VXM, in which the donor-specific antibody (DSA) was prospectively evaluated with the use of single-antigen assays. A total of 42 isolated intestine transplants (13 pediatric and 29 adult) were performed during this time period, with a median follow-up of 20 months (6-40 months). A sensitized (PRA > 20%) group (n = 15) was compared to a control (PRA < 20%) group (n = 27) to evaluate the efficacy of VXM. With the use of VXM, 80% (12/15) of the sensitized patients were transplanted with a negative or weakly positive flow-cytometry crossmatch and 86.7% (13/15) with zero or only low-titer (<1:16) DSA. Outcomes were comparable between sensitized and control recipients, including 1-year freedom from rejection (53.3% and 66.7% respectively, p = 0.367), 1-year patient survival (73.3% and 88.9% respectively, p = 0.197) and 1-year graft survival (66.7% and 85.2% respectively, p = 0.167). In conclusion, a VXM strategy to optimize organ allocation enables sensitized patients to successfully undergo isolated intestinal transplantation with acceptable short-term outcomes.

Original languageEnglish
Pages (from-to)S33-S42
JournalAmerican Journal of Transplantation
Volume12
Issue numberSUPPL 4
DOIs
StatePublished - 2012
Externally publishedYes

Keywords

  • Acute rejection
  • Allosensitization
  • Anti-HLA antibodies
  • Antibody
  • Donor specific
  • Intestine transplant
  • Virtual crossmatch

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