Our Summary

This research paper looks at the role of donor-specific antibodies (DSA) in transplant rejections, specifically in intestinal transplants. The researchers studied 109 transplants performed on 95 patients at one center. They found that 11% of the patients had DSA before their transplant, with half of them still having these antibodies after their transplant. An additional 25% of patients developed DSA after their transplant, and 71% of these patients continued to have these antibodies.

The study found that patients who had DSA before their transplant were at a higher risk of their new organ failing early. Patients who developed DSA after their transplant were more likely to experience quicker organ failure, with a 28% failure rate within two years.

The researchers found that a mismatch in HLA-DQ, a specific type of protein, was a significant risk factor for the development of DSA after a transplant. The strength and specificity of the DSA also predicted whether these antibodies would persist in a patient.

Interestingly, the study found that including the liver in the intestinal transplant provided some protection against transplant rejection. However, this protective effect was lost in patients who continued to have DSA.

The researchers concluded that the presence of DSA leads to worse outcomes for patients who have had an intestinal transplant. They called for more research into how DSA cause organ injury and for better strategies to target these antibodies and improve the long-term success of intestinal transplants.

FAQs

  1. What is the role of donor-specific antibodies (DSA) in transplant rejections?
  2. What factors increase the risk of DSA development after an intestinal transplant?
  3. How does the presence of DSA affect the success rate of intestinal transplants?

Doctor’s Tip

A helpful tip a doctor might tell a patient about intestinal transplant is to closely monitor for the development of donor-specific antibodies (DSA) before and after the transplant. Patients who have DSA before their transplant or develop DSA after the transplant are at a higher risk of organ failure. It is important to discuss this risk with your healthcare team and follow their recommendations for monitoring and managing DSA to improve the long-term success of the transplant.

Suitable For

Patients who are typically recommended for an intestinal transplant are those with intestinal failure, often due to conditions such as short bowel syndrome, inflammatory bowel disease, or congenital anomalies. These patients may have complications such as malnutrition, dehydration, and frequent infections, and are unable to thrive on total parenteral nutrition (TPN) alone. Intestinal transplant may be considered when other treatment options have been exhausted and the patient’s quality of life is significantly impaired.

Additionally, patients who have experienced complications from a previous intestinal transplant, such as chronic rejection, may also be recommended for a repeat transplant. Patients with a high risk of rejection or other complications, such as those with pre-existing donor-specific antibodies, may require additional monitoring and specialized care following their transplant.

Overall, intestinal transplant is typically recommended for patients who have exhausted other treatment options and have a high risk of complications without a transplant. It is important for these patients to be evaluated by a transplant team to determine their eligibility and suitability for the procedure.

Timeline

  • Before intestinal transplant: Patients may have been suffering from intestinal failure due to conditions such as short bowel syndrome, necrotizing enterocolitis, or other gastrointestinal disorders. They would have undergone extensive medical evaluations to determine if they are suitable candidates for a transplant.

  • Day of transplant: The patient would undergo surgery to receive a new intestine from a donor. The transplant procedure can take several hours, and the patient would be closely monitored in the intensive care unit post-surgery.

  • First few weeks post-transplant: The patient would be closely monitored for signs of organ rejection or infection. They would need to take immunosuppressive medications to prevent rejection of the new organ.

  • Months to years post-transplant: The patient would continue to have regular follow-up appointments with their transplant team to monitor their health and adjust medications as needed. They may experience side effects from the immunosuppressive medications and need to manage their diet and lifestyle to support their new intestine.

  • If DSA develops: If the patient develops donor-specific antibodies post-transplant, they would be at a higher risk for organ rejection and may require additional treatments to manage these antibodies. The long-term prognosis for patients with persistent DSA is less favorable, and they may require additional interventions such as re-transplantation.

Overall, the journey before and after an intestinal transplant is complex and requires ongoing care and support from a multidisciplinary team of healthcare providers.

What to Ask Your Doctor

Some questions a patient should ask their doctor about intestinal transplant based on this research include:

  1. What is the role of donor-specific antibodies (DSA) in intestinal transplant rejections?
  2. What percentage of patients develop DSA before or after their transplant?
  3. How does having DSA before or after a transplant impact the success of the transplant?
  4. What is the significance of a mismatch in HLA-DQ in the development of DSA after a transplant?
  5. How do the strength and specificity of DSA predict their persistence in a patient?
  6. How does the inclusion of the liver in the intestinal transplant affect the risk of transplant rejection?
  7. What are the implications of this research for my specific case and potential transplant outcome?
  8. Are there any strategies currently being used to target DSA and improve transplant success?
  9. What further research is needed in this area to improve the long-term success of intestinal transplants?
  10. What steps can I take to mitigate the risks associated with DSA in the transplant process?

Reference

Authors: Cheng EY, Everly MJ, Kaneku H, Banuelos N, Wozniak LJ, Venick RS, Marcus EA, McDiarmid SV, Busuttil RW, Terasaki PI, Farmer DG. Journal: Transplantation. 2017 Apr;101(4):873-882. doi: 10.1097/TP.0000000000001391. PMID: 27490417