Wednesday, December 30, 2015

Abdominal Wall Transplantation: A Sentinel Marker for Rejection

Abdominal wall (AW) transplantation (AWTX) has revolutionized difficult abdominal closure after intestinal transplantation (ITX). More importantly, the skin of the transplanted AW may serve as an immunological tool for differential diagnosis of bowel dysfunction post-transplant. Between 08/2008 and 10/2014, 29 small bowel transplantations were performed in 28 patients (16male;12female; 41±13years). Two groups were identified: The SOT (solid organ transplant)-group (n=15; 12ITX and 3MMVTX) and the SOT+AWTX-group (n=14; 12ITX and 2MMVTX), the latter included one ITX+AWTX retransplantation. Two doses of alemtuzumab were used for induction (30mg, 6 and 24hours post-reperfusion) and tacrolimus (trough levels 8–12ng/ml) was used for maintenance immunosuppression. Patient survival was similar in both groups (67%vs.61%). However, the SOT+AWTX-group showed faster post-transplant recovery, a better intestinal graft survival (79%vs.60%), a lower intestinal rejection rate (7%vs.27%) and a lower rate of misdiagnoses, where viral infection was mistaken and treated for rejection (14%vs.33%). The skin component of the AW may serve as an immune modulator and sentinel marker for immunological activity in the host. This can be a vital tool for timely prevention of intestinal graft rejection and more importantly avoidance of over-immunosuppression in cases of bowel dysfunction not related to graft rejection (read more).