Department of Surgery, University of Illinois at Chicago, Illinois.
Department of Pathology, University of Illinois at Chicago, Illinois.
Transplant Proc. 2023 Mar;55(2):295-302. doi: 10.1016/j.transproceed.2023.01.006. Epub 2023 Feb 18.
Sensitized patients on a waitlist with donor specific antibodies (DSA) or positive flow cytometry cross match (FXM) to deceased donor organ have few pretransplant desensitization options due to increasing graft cold ischemia time. Herein, sensitized simultaneous kidney/pancreas recipients received temporary splenic transplant from the same donor under the hypothesis that spleen would function as a DSA graveyard and provide a safe immunologic window for transplant.
We analyzed presplenic and postsplenic transplant FXM and DSA results of 8 sensitized patients who underwent simultaneous kidney and pancreas transplantation with temporary deceased donor spleen between November 2020 and January 2022.
Pre-splenic transplant, 4 sensitized patients were both T-cell and B-cell FXM positive; one was only B-cell FXM positive and 3 were DSA positive/FXM negative. Post-splenic transplant, all were FXM negative. Pre-splenic transplant class I and class II DSA were detected in 3 patients, only class I DSA in 4 patients, and only class II DSA in 1 patient. Postsplenic transplant, class I DSA was eliminated in all patients. Class II DSA persisted in 3 patients; all showed a marked decrease in DSA mean fluorescence index. Class II DSA was eliminated in one patient.
Donor spleen functions as a DSA graveyard and provides an immunologically safe window for kidney-pancreas transplantation.
在等待具有供体特异性抗体 (DSA) 或流式细胞术交叉匹配阳性 (FXM) 的致敏患者中，由于移植物冷缺血时间增加，移植前脱敏选择很少。在此，假设脾脏将作为 DSA 墓地，并为移植提供安全的免疫窗口，对同时接受肾/胰移植的致敏患者进行了来自同一供体的临时脾脏移植。
我们分析了 2020 年 11 月至 2022 年 1 月期间 8 例接受同时肾和胰腺移植且伴有临时死亡供体脾脏的致敏患者的脾前和脾后 FXM 和 DSA 结果。
脾前移植时，4 例致敏患者均为 T 细胞和 B 细胞 FXM 阳性；1 例仅为 B 细胞 FXM 阳性，3 例为 DSA 阳性/FXM 阴性。脾后移植时，所有患者均为 FXM 阴性。脾前移植时，3 例患者检测到 I 类和 II 类 DSA，4 例患者仅检测到 I 类 DSA，1 例患者仅检测到 II 类 DSA。脾后移植时，所有患者的 I 类 DSA 均被消除。3 例患者 II 类 DSA 持续存在；所有患者的 DSA 平均荧光指数均明显下降。1 例患者的 II 类 DSA 被消除。
供体脾脏作为 DSA 墓地，并为肾-胰移植提供免疫安全窗口。
