Impact of positive flow cytometry crossmatch on outcomes of intestinal/multivisceral transplantation: Role anti-IL-2 receptor antibody

Chandrashekhar A. Kubal, Richard S. Mangus, Rodrigo M. Vianna, Andrew Lobashevsky, Muhammad Mujtaba, Nancy Higgins, Thiago Beduschi, Jonathan A. Fridell, A. Joseph Tector

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Positive crossmatch may be associated with an increased risk of acute rejection (AR) and worse overall outcomes after intestinal/multivisceral (MV) transplantation. However, the evidence from published studies in this setting is sparse and contradictory. This study reports the impact of positive flow cytometry crossmatch on clinical outcomes after intestinal/MV transplantation and the use of anti-interleukin (IL)-2 receptor antibody as a maintenance immunosuppressant. METHODS: Records of all intestinal/MV transplants from 2003 to 2010 were reviewed. Flow cytometry was used to evaluate T- and B-cell crossmatch status. Standard immunosuppression included rabbit anti-thymocyte globulin-rituximab induction with tacrolimus and steroid maintenance. From 2008 onwards (second era), monthly anti-IL-2 receptor antibody was added to the maintenance immunosuppression in patients receiving liver-excluding transplants. RESULTS: Of 131 intestinal/MV transplants, 27 (21%) had a positive crossmatch. Positive crossmatch was not associated with an increased incidence of AR and graft loss (30% and 37% vs. 29% and 47%; P=0.94 and 0.35, respectively). This effect was maintained in liver-excluding transplants. Overall rate of AR decreased from 39% to 22% in the second era. In liver-excluding transplants, there was a significant decrease in AR from 75% to 44% with the use of anti-IL-2 receptor antibody therapy. CONCLUSIONS: With rabbit anti-thymocyte globulin-rituximab induction, positive crossmatch status is not associated with worse outcomes after intestinal/MV transplantation. Use of anti-IL-2 receptor antibody as a part of maintenance immunosuppression may be beneficial in liver-excluding transplants.

Original languageEnglish (US)
Pages (from-to)1160-1166
Number of pages7
JournalTransplantation
Volume95
Issue number9
DOIs
StatePublished - May 15 2013
Externally publishedYes

Fingerprint

Interleukin-2 Receptors
Flow Cytometry
Transplantation
Transplants
Antibodies
Maintenance
Immunosuppression
Antilymphocyte Serum
Liver
Rabbits
Graft Rejection
Tacrolimus
Immunosuppressive Agents
B-Lymphocytes
Steroids
Incidence

Keywords

  • Acute rejection
  • Alloantibody
  • Crossmatch
  • Graft loss
  • Intestinal transplant
  • Rituximab
  • Sensitized recipient

ASJC Scopus subject areas

  • Transplantation

Cite this

Impact of positive flow cytometry crossmatch on outcomes of intestinal/multivisceral transplantation : Role anti-IL-2 receptor antibody. / Kubal, Chandrashekhar A.; Mangus, Richard S.; Vianna, Rodrigo M.; Lobashevsky, Andrew; Mujtaba, Muhammad; Higgins, Nancy; Beduschi, Thiago; Fridell, Jonathan A.; Tector, A. Joseph.

In: Transplantation, Vol. 95, No. 9, 15.05.2013, p. 1160-1166.

Research output: Contribution to journalArticle

Kubal, CA, Mangus, RS, Vianna, RM, Lobashevsky, A, Mujtaba, M, Higgins, N, Beduschi, T, Fridell, JA & Tector, AJ 2013, 'Impact of positive flow cytometry crossmatch on outcomes of intestinal/multivisceral transplantation: Role anti-IL-2 receptor antibody', Transplantation, vol. 95, no. 9, pp. 1160-1166. https://doi.org/10.1097/TP.0b013e3182888df0
Kubal, Chandrashekhar A. ; Mangus, Richard S. ; Vianna, Rodrigo M. ; Lobashevsky, Andrew ; Mujtaba, Muhammad ; Higgins, Nancy ; Beduschi, Thiago ; Fridell, Jonathan A. ; Tector, A. Joseph. / Impact of positive flow cytometry crossmatch on outcomes of intestinal/multivisceral transplantation : Role anti-IL-2 receptor antibody. In: Transplantation. 2013 ; Vol. 95, No. 9. pp. 1160-1166.
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abstract = "BACKGROUND: Positive crossmatch may be associated with an increased risk of acute rejection (AR) and worse overall outcomes after intestinal/multivisceral (MV) transplantation. However, the evidence from published studies in this setting is sparse and contradictory. This study reports the impact of positive flow cytometry crossmatch on clinical outcomes after intestinal/MV transplantation and the use of anti-interleukin (IL)-2 receptor antibody as a maintenance immunosuppressant. METHODS: Records of all intestinal/MV transplants from 2003 to 2010 were reviewed. Flow cytometry was used to evaluate T- and B-cell crossmatch status. Standard immunosuppression included rabbit anti-thymocyte globulin-rituximab induction with tacrolimus and steroid maintenance. From 2008 onwards (second era), monthly anti-IL-2 receptor antibody was added to the maintenance immunosuppression in patients receiving liver-excluding transplants. RESULTS: Of 131 intestinal/MV transplants, 27 (21{\%}) had a positive crossmatch. Positive crossmatch was not associated with an increased incidence of AR and graft loss (30{\%} and 37{\%} vs. 29{\%} and 47{\%}; P=0.94 and 0.35, respectively). This effect was maintained in liver-excluding transplants. Overall rate of AR decreased from 39{\%} to 22{\%} in the second era. In liver-excluding transplants, there was a significant decrease in AR from 75{\%} to 44{\%} with the use of anti-IL-2 receptor antibody therapy. CONCLUSIONS: With rabbit anti-thymocyte globulin-rituximab induction, positive crossmatch status is not associated with worse outcomes after intestinal/MV transplantation. Use of anti-IL-2 receptor antibody as a part of maintenance immunosuppression may be beneficial in liver-excluding transplants.",
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T2 - Role anti-IL-2 receptor antibody

AU - Kubal, Chandrashekhar A.

AU - Mangus, Richard S.

AU - Vianna, Rodrigo M.

AU - Lobashevsky, Andrew

AU - Mujtaba, Muhammad

AU - Higgins, Nancy

AU - Beduschi, Thiago

AU - Fridell, Jonathan A.

AU - Tector, A. Joseph

PY - 2013/5/15

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N2 - BACKGROUND: Positive crossmatch may be associated with an increased risk of acute rejection (AR) and worse overall outcomes after intestinal/multivisceral (MV) transplantation. However, the evidence from published studies in this setting is sparse and contradictory. This study reports the impact of positive flow cytometry crossmatch on clinical outcomes after intestinal/MV transplantation and the use of anti-interleukin (IL)-2 receptor antibody as a maintenance immunosuppressant. METHODS: Records of all intestinal/MV transplants from 2003 to 2010 were reviewed. Flow cytometry was used to evaluate T- and B-cell crossmatch status. Standard immunosuppression included rabbit anti-thymocyte globulin-rituximab induction with tacrolimus and steroid maintenance. From 2008 onwards (second era), monthly anti-IL-2 receptor antibody was added to the maintenance immunosuppression in patients receiving liver-excluding transplants. RESULTS: Of 131 intestinal/MV transplants, 27 (21%) had a positive crossmatch. Positive crossmatch was not associated with an increased incidence of AR and graft loss (30% and 37% vs. 29% and 47%; P=0.94 and 0.35, respectively). This effect was maintained in liver-excluding transplants. Overall rate of AR decreased from 39% to 22% in the second era. In liver-excluding transplants, there was a significant decrease in AR from 75% to 44% with the use of anti-IL-2 receptor antibody therapy. CONCLUSIONS: With rabbit anti-thymocyte globulin-rituximab induction, positive crossmatch status is not associated with worse outcomes after intestinal/MV transplantation. Use of anti-IL-2 receptor antibody as a part of maintenance immunosuppression may be beneficial in liver-excluding transplants.

AB - BACKGROUND: Positive crossmatch may be associated with an increased risk of acute rejection (AR) and worse overall outcomes after intestinal/multivisceral (MV) transplantation. However, the evidence from published studies in this setting is sparse and contradictory. This study reports the impact of positive flow cytometry crossmatch on clinical outcomes after intestinal/MV transplantation and the use of anti-interleukin (IL)-2 receptor antibody as a maintenance immunosuppressant. METHODS: Records of all intestinal/MV transplants from 2003 to 2010 were reviewed. Flow cytometry was used to evaluate T- and B-cell crossmatch status. Standard immunosuppression included rabbit anti-thymocyte globulin-rituximab induction with tacrolimus and steroid maintenance. From 2008 onwards (second era), monthly anti-IL-2 receptor antibody was added to the maintenance immunosuppression in patients receiving liver-excluding transplants. RESULTS: Of 131 intestinal/MV transplants, 27 (21%) had a positive crossmatch. Positive crossmatch was not associated with an increased incidence of AR and graft loss (30% and 37% vs. 29% and 47%; P=0.94 and 0.35, respectively). This effect was maintained in liver-excluding transplants. Overall rate of AR decreased from 39% to 22% in the second era. In liver-excluding transplants, there was a significant decrease in AR from 75% to 44% with the use of anti-IL-2 receptor antibody therapy. CONCLUSIONS: With rabbit anti-thymocyte globulin-rituximab induction, positive crossmatch status is not associated with worse outcomes after intestinal/MV transplantation. Use of anti-IL-2 receptor antibody as a part of maintenance immunosuppression may be beneficial in liver-excluding transplants.

KW - Acute rejection

KW - Alloantibody

KW - Crossmatch

KW - Graft loss

KW - Intestinal transplant

KW - Rituximab

KW - Sensitized recipient

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