ArticleIntestinal Failure (New York, N.Y.)
Tailoring desensitization in intestinal transplants: C1q guided protocol for highly sensitized recipients.
Article in Intestinal Failure (New York, N.Y.). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Background: Sensitized candidates for isolated intestinal or modified multivisceral transplantation (MMVT) face prolonged wait times and higher rejection risk from donor-specific antibodies (DSA). While desensitization is established in kidney transplantation, data in intestine/MMVT are limited. Case report: Three adults with cPRA ≥ 95% underwent desensitization with Rituximab, plasma exchange, and monthly infusions of IgG, guided by C1q DSA testing. All three patients were transplanted-two with negative crossmatches and one despite a positive B-cell crossmatch given C1q-negative DSAs. No early AMR occurred; one developed mild acute cellular rejection, responsive to therapy. Infectious complications were common but manageable. Outcomes varied: one died nearly four years post-transplant from non-adherence leading to infections and severe rejection, one succumbed to necrotizing fasciitis at 10 months with a functional graft, and one remains alive with excellent graft function. Conclusion: C1q-guided desensitization enabled successful transplantation in highly sensitized isolated intestine/MMVT recipients, supporting its feasibility. Further clinical studies are warranted.
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