Analysis of immune cells draining from the abdominal cavity as a novel tool to study intestinal transplant immunobiology. Prospective multicenter study - INIGMA project

PARADA MONCADA ALBANIS; SOLAR HECTOR; HERLENIUS G; FERNANDEZ OLIVEROS FRANCISCO; RUMBO MARTIN; PUCCI MOLINERS M; RUMBO CAROLINA; CEULEMANS L; JAVIER SARDILLI; GONDOLESI GABRIEL; GENTILINI MV; DOEYO MARIANA ; OLTEAN MIHAI; PIRENNE J; MEIER DOMINIK

Congreso; CIRTA 2019; 2019

We proved that abdominal drainage fluid collected after intestinal transplant (ITx)contains mainly immune cells trafficking from the implanted intestine, and changes ofimmune cell composition, especially increase of neutrophils, correlated with theappearance of future clinical events (rejection, infection or other events). During the14th ISBTS meeting, the development of a prospective multicenter study to analyzethe role of performing daily analysis of drainage samples that might serve as a reliabletool for predicting clinical events, was proposed. We aim to present the preliminaryresults of the INIGMA (International Network for Intestinal Graft Monitoring andAnalysis) project. Material and Methods: This is a prospective study started in 2008 byFavaloro University Hospital, Argentina, and evolved as a multicenter study in 2015,including the University of Gothenburg, Sweden; University of Leuven, Belgium andLa Paz University Hospital, Spain. The cell composition of the abdominal draining fluidand blood was analyzed during the first post-op days by differential cell counter andcorrelation with clinical follow-up was evaluated. Results: 3 of the 4 centers enrolled28 patients (pts) with complete biochemical and clinical information (Table 1). The cellcomposition differs from blood and draining fluid; independently of theimmunosuppressive protocol used, blood samples obtained the day of the Tx showedan almost complete lymphopenia, while neutrophils were the main population (19/28pts). In the drains, lymphocytes were the main population counted in non-complicatedpts from post-op day 3 to 4 onwards (7/28 pts). When a new shift to a neutrophildominant content is observed in the drainage, it anticipates the development of aclinical event in the peritoneal cavity (18/28 pts). Table 2 summarizes the correlationbetween neutrophils and clinical events; Fischer test: p=0.0002. Sensitivity=90%;Specificity=86%; PPV=94.7%, NPV=75%. Conclusion: this study supports the conceptthat multicenter studies are feasible in our field. This analysis validates the findings ofthe original report, and provides further support to use this innovative approach tomonitor the grafts and the transplanted pts. Cell counts from the drainage should beincluded as part of the daily evaluation of pts receiving an ITx, any shift fromlymphocytic to neutrophilic dominance predicts the occurrence of a clinical events,requiring attention, early confirmation and treatment.