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

MARÍA VIRGINIA GENTILINI; MARIANA DOEYO; MIHAI OLTEAN; JACQUES PIRENNE; DOMINIK MEIER; MELISA PUCCI MOLINERIS; CAROLINA RUMBO; LAURENS CEULEMANS; JAVIER SARDILLI; GABRIEL E GONDOLESI; ALBANIS PARADA MONCADA; HECTOR SOLAR MUÑIZ; GUSTAF HERLENIUS ; FRANCSICO HERNANDEZ OLIVEROS; MARTIN RUMBO

Paris

Congreso; XVI International Congress of Intestinal rehabilitation and Transplant association; 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 reliable tool for predicting clinical events, was proposed. We aim to present the preliminary results of the INIGMA (International Network for Intestinal Graft Monitoring and Analysis) project. Material and Methods: This is a prospective study started in 2008 by Favaloro 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 fluid and blood was analyzed during the first post-op days by differential cell counter and correlation with clinical follow-up was evaluated. Results: 3 of the 4 centers enrolled 28 patients (pts) with complete biochemical and clinical information (Table 1). The cell composition differs from blood and draining fluid; independently of the immunosuppressive protocol used, blood samples obtained the day of the Tx showed an almost complete lymphopenia, while neutrophils were the main population (19/28pts). In the drains, lymphocytes were the main population counted in non-complicated pts from post-op day 3 to 4 onwards (7/28 pts). When a new shift to a neutrophil dominant content is observed in the drainage, it anticipates the development of a clinical 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 concept that multicenter studies are feasible in our field. This analysis validates the findings of the original report, and provides further support to use this innovative approach to monitor the grafts and the transplanted pts. Cell counts from the drainage should be included as part of the daily evaluation of pts receiving an ITx, any shift from lymphocytic to neutrophilic dominance predicts the occurrence of a clinical events,requiring attention, early confirmation and treatment.