Therapeutic Plasma Exchange in Small-Bowel Transplant Recipients

Bobr Aleh,Shunkwiler Sara M,Reid Whitney L,Koepsell Scott A,Cox Jesse L

doi:10.23937/2572-4045.1510056

Abstract

Highlights

Therapeutic plasma exchange (TPE) is an important adjunct therapy to reduce levels of donor-specific antibodies (DSAs) associated with antibody mediated rejection (AMR) in solid organ transplant recipients, especially kidney recipients
To determine potential benefits of TPE toward mitigating small bowel transplant rejection, we examined three different parameters in the post-apheresis period: 1) DSA presence and strength; 2) Histopathologic findings in allograft biopsies; 3) Clinical response
There was a trend in existing DSA strength decrease and disappearance, more pronounced in the third time period after TPE

Summary

Introduction

Therapeutic plasma exchange (TPE) is an important adjunct therapy to reduce levels of donor-specific antibodies (DSAs) associated with antibody mediated rejection (AMR) in solid organ transplant recipients, especially kidney recipients. The purpose of this study was to examine the effect of TPE on DSAs and clinical/pathologic evidence of rejection in small bowel transplant recipients. Patients undergo routine surveillance endoscopy with allograft biopsies to evaluate for the histologic features associated with acute cellular rejection, such as increased mononuclear cell infiltrate, epithelial injury, and increased apoptosis within the intestinal crypts [3]. Oftentimes, these histologic features appear prior to the development of any clinical symptoms such as increased watery ileostomy output, abdominal pain, nausea, vomiting, diarrhea, or fever. Recognition of acute cellular rejection allows clinicians to intervene in the rejection process before clinical manifestation by increasing the activity of anti-rejection medications

Objectives

Methods

Results

Discussion

Conclusion