Transplant-associated thrombotic microangiopathy and immune haematological complications following intestine-containing organ transplantation: experience from over 100 consecutive cases.
ABO Blood-Group System
/ immunology
Adult
Antibodies, Monoclonal, Humanized
/ administration & dosage
Bortezomib
/ administration & dosage
Female
Follow-Up Studies
Hemolysis
/ immunology
Humans
Intestines
/ transplantation
Isoantibodies
/ immunology
Male
Middle Aged
Neutropenia
/ drug therapy
Organ Transplantation
/ adverse effects
Retrospective Studies
Rituximab
/ administration & dosage
Thrombasthenia
/ drug therapy
Thrombotic Microangiopathies
/ drug therapy
immunohaematology
intestinal transplantation
multi-visceral transplantation
passenger lymphocyte syndrome
transplant-associated thrombotic microangiopathy
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
02
03
2021
received:
04
01
2021
accepted:
02
03
2021
pubmed:
7
5
2021
medline:
29
9
2021
entrez:
6
5
2021
Statut:
ppublish
Résumé
Descriptions of passenger lymphocyte syndrome (PLS), immune cytopenias and transplant-associated thrombotic microangiopathy (TA-TMA) after intestine-containing transplants remain scarce. We describe our centre's experience of these complications from 2007 to 2019. Ninety-six patients received 103 transplants. PLS occurred in 9 (9%) patients (median 12 days post-transplant); all due to ABO antibodies. There were 31 minor ABO mismatch transplants. No patient required change in immunosuppression. Immune cytopenias (excluding PLS) occurred in six patients at an incidence of 1·7/100 patient years; three immune haemolysis, one immune thrombocytopenia, one acquired Glanzmann's and one immune neutropenia; 50% occurred with other cytopenias. All cases eventually responded to treatment, with a median of four treatments (range 1-8) and 5/6 were treated with rituximab. One patient with immune haemolysis required bortezomib. Complications were common in patients with immune cytopenias; 4/6 with infection needing intravenous antibiotics and 3/6 with venous thromboembolism. In 3/6 cases, a secondary cause for the immune cytopenia was evident. Switching from tacrolimus to ciclosporin was not necessary. There were five cases of transplant-associated thrombotic microangiopathy (TA-TMA; 1·5/100 patient years) requiring calcineurin inhibitor withdrawal; two cases associated with acute rejection. Two cases were managed with plasma exchange, one with plasma infusions and one with eculizumab. Further research in this patient group is required.
Substances chimiques
ABO Blood-Group System
0
Antibodies, Monoclonal, Humanized
0
Isoantibodies
0
Rituximab
4F4X42SYQ6
Bortezomib
69G8BD63PP
eculizumab
A3ULP0F556
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
961-970Informations de copyright
© 2021 British Society for Haematology and John Wiley & Sons Ltd.
Références
Barry M, Chandra S, Hymes KB. Cytopenias in transplant patients. Principles and Practice of Transplant Infectious Diseases. 2018;199-207.
Romero S, Solves P, Lancharro A, Cano I, Moscardó F, Carpio N, Sanz MÁ, et al. Passenger lymphocyte syndrome in liver transplant recipients: a description of 12 cases. Blood Transfus. 2015;13(3):423-8.
Ramsey G. Red cell antibodies arising from solid organ transplants. Transfusion. 1991;31:76-86.
Schoettler M, Elisofon SA, Kim HB, Blume ED, Rodig N, Boyer D, et al. Treatment and outcomes of immune cytopenias following solid organ transplant in children. Pediatr Blood Cancer. 2015;62(2):214-8.
Taylor RM, Bockenstedt P, Su GL, Marrero JA, Pellitier SM, Fontana RJ. Immune thrombocytopenic purpura following liver transplantation: a case series and review of the literature. Liver Transpl. 2006;12(5):781-91.
Retana AK, Kaplan MM, Erban JK. Autoimmune hemolytic anemia in patients with liver transplants for primary biliary cirrhosis: three case reports and a review of the literature. Am J Gastroenterol. 2007;102:197-200.
Verbiest A, Pirenne J, Dierickx D. De novo thrombotic microangiopathy after non-renal solid organ transplantation. Blood Rev. 2014;28(6):269-79.
Rutter CS, Amin I, Russell NK, Sharkey LM, Butler AJ, Middleton SJ. Adult intestinal and multivisceral transplantation: experience from a single center in the United Kingdom. Transplant Proc. 2016;48(2):468-72.
Bharadwaj S, Tandon P, Gohel TD, Brown J, Steiger E, Kirby DF, et al. Current status of intestinal and multivisceral transplantation. Gastroenterol Rep (Oxf). 2017;5(1):20-8.
Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American society of hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-66.
Hill QA, Stamps R, Massey E, Grainger JD, Provan D, Hill A; British Society for Haematology Guidelines. Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia. Br J Haematol. 2017;177(2):208-20.
Cohen Z, Silverman RE, Wassef R, Levy GA, Burnstein M, Cullen J, et al. Small intestinal transplantation using cyclosporine. Report of a case. Transplantation. 1986;42(6):613-21.
Sindhi R, Landmark J, Shaw BW Jr, Fox IJ, Heffron TG, Vanderhoof J, et al. Combined liver/small bowel transplantation using a blood group compatible but nonidentical donor. Transplantation. 1996;61:1782-3.
Panaro F, DeChristopher PJ, Rondelli D, Testa G, Sankary H, Popescu M, Benedetti E. Severe haemolytic anemia due to passenger lymphocytes after living related bowel transplant. Clin Transplant. 2004;18:332-5.
Makuria AT, Langeberg A, Fishbein TM, Sandler SG. Nonhemolytic passenger lymphocyte syndrome: donor-derived anti-M in an M+ recipient of a multiorgan transplant. Immunohematology. 2009;25(1):20-3.
Davis SL, Vaidya A, Timbs A, Staves J, Murphy MF. Severe haemolysis due to passenger lymphocyte syndrome after an ABO mismatched bowel transplant-a case report. Transfus Med. 2011;21:65-9.
Chua CC, Lim H, Testro A, Hong FS. Passenger lymphocyte syndrome due to anti-B and anti-Jka following combined intestinal and renal transplantation. VOXS. 2019;14:183-6.
Foell D, Glasmeyer S, Senninger N, Wolters H, Palmes D, Bahde R. Successful management of passenger lymphocyte syndrome in an ABO-compatible, nonidentical isolated bowel transplant: a case report and review of the literature. Transfusion. 2017;57(6):1396-400.
Botija G, Ybarra M, Ramos E, Molina M, Sarría J, Martínez-Ojinaga E, et al. Autoimmune cytopaenia after paediatric intestinal transplantation: a case series. Transpl Int. 2010;23(10):1033-7.
Lauro A, Stanzani M, Finelli C, Zanfi C, Morelli MC, Pasqualini E, et al. Alemtuzumab plus cyclosporine treatment of the autoimmune hemolytic anemia in an adult bowel transplant. Case Rep Transplant. 2014;2014:262953.
Hill QA, Harrison LC, Padmakumar AD, Owen RG, Prasad KR, Lucas GF, et al. A fatal case of transplantation-mediated alloimmune thrombocytopenia following liver transplantation. Hematology. 2017;22(3):162-7.
Trotter P, Robb M, Summers D, Watson C, Clatworthy M, Bradley J, et al. Donors With Immune Thrombocytopenia: Do They Pose a Risk to Transplant Recipients? Am J Transplant. 2017;17:796-802.
Costelloe L, Jones J, Coles A. Secondary autoimmune diseases following alemtuzumab therapy for multiple sclerosis. Expert Rev Neurother. 2012;12(3):335-41.
Cuker A, Coles AJ, Sullivan H, Fox E, Goldberg M, Oyuela P, et al. A distinctive form of immune thrombocytopenia in a phase 2 study of alemtuzumab for the treatment of relapsing-remitting multiple sclerosis. Blood. 2011;118(24):6299-305.
Fadlallah J, Michel M, Crickx E, Limal N, Costedoat N, Malphettes M, et al. Bortezomib and dexamethasone, an original approach for treating multi-refractory warm autoimmune haemolytic anaemia. Br J Haematol. 2019;187:124-8.
Knops N, Emonds MP, Herman J, Levtchenko E, Mekahli D, Pirenne J, et al. Bortezomib for autoimmune hemolytic anemia after intestinal transplantation. Pediatr Transplant. 2020;24(4):e13700.
Bull T, Jolley R, Martin-Cabrera P, Thomas W. Autoimmune pancytopenia occurring late after simultaneous pancreas and kidney transplantation. BMJ Case Rep. 2020;13(9):e235851.
Mathew A, Woytowitz D, Smith RE, Mehta RP. Tacrolimus-induced refractory immune thrombocytopenia in solid organ transplant patients. Blood. 2013;122(21):2317.
Acquazzino MA, Fischer RT, Langnas A, Coulter DW. Refractory autoimmune hemolytic anemia after intestinal transplant responding to conversion from a calcineurin to mTOR inhibitor. Pediatr Transplant. 2013;17(5):466-71.
Nurden AT. Acquired Glanzmann thrombasthenia: from antibodies to anti-platelet drugs. Blood Rev. 2019;36:10-22.
Abbas F, El Kossi M, Kim JJ, Sharma A, Halawa A. Thrombotic microangiopathy after renal transplantation: current insights in de novo and recurrent disease. World J Transplant. 2018;8(5):122-41.
Humar A, Jessurun J, Sharp HL, Gruessner RW. Hemolytic uremic syndrome in small bowel transplant recipients: the first two case reports. Transpl Int. 1999;12(5):387-90.
Banerjee D, Kupin W, Roth D. Hemolytic uremic syndrome after multivisceral transplantation treated with intravenous immunoglobulin. J Nephrol. 2002;16(5):733-5.
Dierickx D, Monbaliu D, De Rycke A, Wisanto E, Lerut E, Devos T, et al. Thrombotic microangiopathy following intestinal transplantation: a single center experience. Transplant Proc. 2010;42(1):79-81.
Paramesh AS, Grosskreutz C, Florman SS, Gondolesi G, Sharma S, Kaufman S, et al. Thrombotic microangiopathy associated with combined sirolimus and tacrolimus immunosuppression after intestinal transplantation. Transplantation. 2004;77(1):129-31.