P-17: Transplant Associated Thrombotic Microangiopathy and Immune Haematological Complications Following Intestine Containing Organ Transplantation: Experience from Over 100 Consecutive Cases

Abstract

Descriptions of passenger lymphocyte syndrome (PLS), immune cytopenias and transplant associated thrombotic microangiopathy (TA-TMA) in patients with intestine-containing grafts remains scarce. We describe our experience of these complications in a retrospective chart review from 2007-2019. 96 patients received 103 transplants. PLS occurred in 9 (9%) patients (median 12 days post-transplant); all due to ABO antibodies. There were 31 minor ABO mismatch transplants. No patient required change in immunosuppression. Immune cytopenias (excluding PLS) occurred in 6 patients at an incidence of 1.6/100 years follow-up; 3 immune haemolysis, 1 immune thrombocytopenia, 1 acquired Glanzmann’s and 1 immune neutropenia; 50% occurred with other cytopenias. All cases responded to treatment, with a median of 5 treatments (range 1–8) and 5/6 required rituximab. 1 patient with immune haemolysis required bortezomib. Complications of infection or thrombosis were common. In 3/6 cases a secondary cause for the immune cytopenia was evident. Switching from tacrolimus to ciclosporin wasn’t necessary. There were 5 cases of TA-TMA (1.3/100 patient years) requiring calcineurin inhibitor withdrawal; 2 cases associated with acute rejection. 2 cases were managed with plasma exchange and 1 with eculizumab. We describe extensive experience for this patient group, in the largest published series, where further research collaboration or a research registry is needed.