G Bond

The impact of positive T-cell lymphocytotoxic crossmatch on intestinal allograft rejection and survival

A positive antidonor T-cell lymphocytotoxic crossmatch (X-M) has been shown to have a deleterious effect on graft survival after solid organ transplantation.1–3 This is the first report to address the impact of preformed antidonor IgG lymphocytotoxic antibodies on intestinal allograft rejection and survival.

De novo malignancies after intestinal and multivisceral transplantation

Background. Maintenance immunosuppression required after organ transplantation creates a permissive environment in which cancer cells can proliferate because of lack of natural immunologic surveillance. With more than a decade of clinical experience, this report is the first to address the risk of de novo cancer after intestinal transplantation. Methods. A total of 168 consecutive intestinal transplant recipients (86 children and 82 adults) were studied, of whom 52% were male and 91% were white. Surveillance, Epidemiology, and End Results data was used to count expected rates of de novo cancers in the general population matched for age, sex, and length of follow-up. Results. With a mean follow-up of 47±41 months, 7 (4.2%) patients developed nonlymphoid de novo cancer, with a cumulative risk of 3% at 5 years and 28% at 10 years. Of these malignancies, one was donor-driven adenocarcinoma. With 0.58 being the expected rate of malignancy for the general population, the risk among intestinal recipients was 8.7 times higher (P =0.01). Such morbidity was significantly higher (50 times) among younger patients (<25 years), with a slight male preponderance. Induction immunosuppression was associated with early onset of de novo cancer. Patient survival after diagnosis of de novo cancer was 72% at 1 year, 57% at 2 years, and 29% at 5 years. Conclusion. With conventional immunosuppression, intestinal recipients are at a significantly higher risk of developing de novo cancer when compared with the general population. Thus, a novel tolerogenic immunosuppressive strategy has been recently implemented to reduce the lifelong need for immunosuppression.

Treatment of tardive dyskinesia with levetiracetam in a transplant patient

Objective –  To describe successful treatment of tardive dyskinesia with levetiracetam.

Molecular inflammatory events within the human intestinal muscularis during small bowel transplantation.

IT HAS BEEN previously reported that ischemia and reperfusion, hemorrhagic shock, or gentle intestinal manipulation in rodents evokes a molecular and cellular inflammatory response within the intestinal muscularis that is associated with a decrease in intestinal motility. To determine whether these observations are relevant to the clinical setting of human small bowel transplantation, we investigated the expression of inflammatory mediators during the transplantation procedure where ichemia/reperfusion and intestinal handling are unavoidable. Furthermore we hypothesized that the inflammatory cascade commences early during graft harvest.

Isolated intestinal versus composite visceral allografts: Causes of graft failure

Although tacrolimus-based immunosuppression has made clinical intestinal transplantation feasible, the risk of the requisite long-term high-dose treatment has inhibited the widespread use of these procedures. 1 Such a risk could be partially eliminated with safe adjustment of the current immunosuppressive management protocol according to the type of intestinal allograft.

Pediatric intestinal transplantation

The field of intestinal transplantation has experienced dramatic growth since the first reported cases 3 decades ago. Improvements in operative technique, donor assessment and immunosuppressive protocols have afforded children who suffer from life-threatening complications of intestinal failure a chance at long-term survival. As experience has grown, newer diseases, with more systemic manifestations have arisen as potential indications for transplant. After discussing the historical developments of intestinal transplant as a backdrop, this review focuses on the specific pre-operative indications for transplant as well as the great success that intestinal rehabilitation has witnessed over the past decade. A detailed discussion of evolution of immunosuppressive strategies is followed a general review of the common infectious complications experienced by children after intestinal transplant as well as the current long- and short-term results, including a section on new research on the quality of life in this challenging population of patients.