ANALYSIS OF THE IMPACT OF INITIAL POST-OPERATIVE CLINICAL OUTCOME AFTER INTESTINAL TRANSPLANTATION ON THE INCIDENCE OF EARLY ACUTE CELLULAR REJECTION IN A SINGLE CENTER

AGUSTINA ZAMBERNARDI; CABANNE, ANA; GONZALEZ PEDRO; MARTIN RUMBO; CHIODETTI ANA; PADIN JUAN; CAROLINA RUMBO; GABRIEL E. GONDOLES

Congreso; XII International Small Bowel Transplantation Symposium; 2011

<!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} span.hps {mso-style-name:hps;} span.hpsatn {mso-style-name:"hps atn";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 3.0cm 70.85pt 3.0cm; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> Introduction: Different factors such as pre-transplant immunological risk (IR), degree of ischemia reperfusion injury (IRI) and immunosuppression scheme have been associated with an increase risk for early acute cellular rejection (EACR) after intestinal transplant (ITx). The relationship between the immediate post ITx clinical outcome and EACR risk has been proposed but seldom documented. Our aim was to analyze the impact of initial adverse clinical events in the occurrence of EACR (1st month) in our cohort of patients. Material and Methods: Retrospective analysis of 23 isolated and combined ITx performed between 3-2006 and 2-2011. Variables: Total ischemia time (TIT)/Warm ischemia time (WIT), IRI (Park Index and MDA histochemistry), IR, induction and maintenance immunosuppression (IS), achievement of drug target level (ATL), incidence of EACR (mild, moderate and severe), surgical complications (SC) and severe infectious complications (IC), overall rejection free and patient survival. Patients were divided into 3groups: Group 1: IC + SC (n = 10); Group 2:SC (n =5) and Group 3no-complications (n = 8). Results: TIT/WIT, IRI, IS according to IR could not be associated with the occurrence of EACR. Adverse clinical outcome showed a clear association with EACR (9/10 in group 1; 3/5 in group 2; 1/8 in group 3, p=0.0015). Non ATL was associated with EACR: 5/5 in group 1 (all severe), 3/5 in group 2 (all mild). However, patients with optimal ATL also presented ACR: 4/5 (all mild) in group 1 and 1/8 (mild) in group 3. (p=NS). Among patients who underwent severe EACR (n=5), 3/5 were treated and recovered (only one of them presented 2 new episodes of mild ACR in 5 years of follow up) and 2/5 died with concomitant severe CMV infection. The rejection-free survival was significantly lower (p<0.02) in group 1 (95% CI 12-45 days) than group 3 (95% CI 55-856 days). Patient survival at 950 days of follow-up (overall mean survival time) was 70% group 1, 80% group 2 and 100% group 3 (p=NS). Conclusion: 1- IC has been the most important risk factor to develop EACR, even in patientswith optimal IS level.  2- Decreased levels of IS in patients with severe infection was associated with high risk to evolve to severe EACR. 3- If timely diagnosed severe EACR could be successfully treated. 4- In our cohort occurrence of EACR did not impact on long term patient survival or graft loss.