Huard Genevieve, Schiano Thomas D, Moon Jang, Iyer Kishore
Intestinal Transplant Program, Recanati Miller Transplant Institute, The Mount Sinai Medical Center, New York, NY, USA.
Division of Liver Diseases, Department of Medicine, The Mount Sinai Medical Center, New York, NY, USA.
Clin Transplant. 2017 May;31(5). doi: 10.1111/ctr.12956. Epub 2017 Mar 31.
Severe acute cellular rejection (ACR) occurs frequently after intestinal transplantation (ITx).
To evaluate the outcomes and the risk factors for graft failure and mortality in patients with severe ACR after ITx.
Retrospective study evaluating all ITx recipients who developed severe ACR between 01/2000 and 07/2014. Demographic and histologic data were reviewed.
20/126 (15.9%) ITx recipients developed severe ACR. Of these 20 episodes, 13 were in adults (median age: 47.1). The median (IQR) time from ITx to severe ACR was 206.5 (849) days. All patients received intravenous methylprednisolone and increased doses of tacrolimus. Sixteen (80%) patients did not respond to initial treatment and required thymoglobulin administration. Moreover, 11 (55%) patients required additional immunosuppressive medications. Six (30%) patients required graft enterectomy. Complications related to ACR treatment were the following: 10 (50%) patients developed bacterial infections, four (20%) patients developed cytomegalovirus infection and four (20%) patients developed post-transplant lymphoproliferative disease. At the end of follow-up, only 3/20 (15%) were alive with a functional allograft. The median patient survival time after diagnosis of severe ACR was 400 days (95% CI: 234.0-2613.0).
Severe ACR episodes are associated with high rates of graft loss and complications related to treatment.
严重急性细胞排斥反应（ACR）在肠道移植（ITx）后频繁发生。
评估ITx后发生严重ACR患者的移植失败和死亡结局及危险因素。
回顾性研究评估2000年1月至2014年7月间发生严重ACR的所有ITx受者。回顾人口统计学和组织学数据。
126例ITx受者中有20例（15.9%）发生严重ACR。在这20次发作中，13例为成人（中位年龄：47.1岁）。从ITx到严重ACR的中位（IQR）时间为206.5（849）天。所有患者均接受静脉注射甲泼尼龙并增加他克莫司剂量。16例（80%）患者对初始治疗无反应，需要给予抗胸腺细胞球蛋白。此外，11例（55%）患者需要额外的免疫抑制药物。6例（30%）患者需要进行移植肠切除术。与ACR治疗相关的并发症如下：10例（50%）患者发生细菌感染，4例（20%）患者发生巨细胞病毒感染，4例（20%）患者发生移植后淋巴细胞增生性疾病。随访结束时，仅20例中的3例（15%）存活且移植肠功能正常。诊断为严重ACR后的中位患者生存时间为400天（95%CI：234.0 - 2613.0）。
严重ACR发作与移植丢失率高及治疗相关并发症有关。
