PMID- 36416299
OWN - NLM
STAT- MEDLINE
DCOM- 20230314
LR  - 20230318
IS  - 1399-0012 (Electronic)
IS  - 0902-0063 (Linking)
VI  - 37
IP  - 3
DP  - 2023 Mar
TI  - Successful combined auxiliary partial liver and intestinal transplantation in two 
      highly sensitized, cross-match positive patients.
PG  - e14865
LID - 10.1111/ctr.14865 [doi]
AB  - INTRODUCTION: Sensitization to human leukocyte antigen (HLA) creates an 
      immunological barrier to intestinal transplantation (ITx). Current 
      desensitization therapies are limited and ineffective in the most highly 
      sensitized patients. A co-transplanted whole liver transplant can protect a 
      kidney, heart, or intestinal allograft from antibody-mediated injury. Whether an 
      auxiliary partial liver allograft provides effective protection for highly 
      sensitized intestinal transplant recipients is unknown. METHODS: Two patients 
      with strong HLA donor-specific antibody at high titer against their deceased 
      donors underwent combined auxiliary partial liver and ITx across a positive 
      cross-match. The left lateral lobes from the combined-graft recipients and the 
      right liver lobes from the deceased donors were transplanted as a domino 
      procedure to other four patients. RESULTS: Two combined-graft recipients have had 
      an uneventful postoperative course without major complications at a 12- and 
      24-month follow-up, respectively. Intestinal graft function has been excellent 
      with no evidence of humoral or cellular rejection. While a positive cross-match 
      turned negative, titers of donor-specific HLA antibodies gradually declined over 
      time after transplant. The left liver lobes procured from the combined-graft 
      recipients were successfully transplanted into two pediatric patients (age 1.9, 
      2.4 years) and the right lobes from two deceased donors were successfully 
      transplanted into two adult patients. All transplant procedures went well, 
      without post-operative complications related to the splitting technique. 
      CONCLUSION: Our results indicate that an auxiliary liver transplant can 
      effectively protect a co-transplanted intestinal allograft against rejection and 
      suggest that this combined procedure may serve as a useful therapeutic adjunct 
      for a highly sensitized intestinal transplant candidate.
CI  - (c) 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Wu, Guosheng
AU  - Wu G
AD  - Intestinal Transplant Center, The First Affiliated Hospital, Zhejiang University 
      School of Medicine, Hangzhou, China.
FAU - Liu, Chaoxu
AU  - Liu C
AD  - Intestinal Transplant Center, The First Affiliated Hospital, Zhejiang University 
      School of Medicine, Hangzhou, China.
FAU - Ma, Nan
AU  - Ma N
AD  - Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Zhou, Xile
AU  - Zhou X
AD  - Intestinal Transplant Center, The First Affiliated Hospital, Zhejiang University 
      School of Medicine, Hangzhou, China.
FAU - Zhao, Long
AU  - Zhao L
AD  - Intestinal Transplant Center, The First Affiliated Hospital, Zhejiang University 
      School of Medicine, Hangzhou, China.
FAU - Zhang, Yuntao
AU  - Zhang Y
AD  - Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Zhang, Wentong
AU  - Zhang W
AD  - Intestinal Transplant Center, The First Affiliated Hospital, Zhejiang University 
      School of Medicine, Hangzhou, China.
FAU - Liang, Tingbo
AU  - Liang T
AD  - Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
AD  - Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
AD  - Zhejiang University Cancer Center, Zhejiang University, Hangzhou, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230109
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (Antibodies)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Child
MH  - *Kidney Transplantation/methods
MH  - Kidney
MH  - Antibodies
MH  - Liver
MH  - Transplantation, Homologous
OTO - NOTNLM
OT  - auxiliary partial liver transplantation
OT  - intestinal transplantation
OT  - positive cross-match
OT  - sensitization
EDAT- 2022/11/24 06:00
MHDA- 2023/03/15 06:00
CRDT- 2022/11/23 06:42
PHST- 2022/09/09 00:00 [revised]
PHST- 2022/07/14 00:00 [received]
PHST- 2022/10/29 00:00 [accepted]
PHST- 2022/11/24 06:00 [pubmed]
PHST- 2023/03/15 06:00 [medline]
PHST- 2022/11/23 06:42 [entrez]
AID - 10.1111/ctr.14865 [doi]
PST - ppublish
SO  - Clin Transplant. 2023 Mar;37(3):e14865. doi: 10.1111/ctr.14865. Epub 2023 Jan 9.