Artikel
Abdominal wall transplantation: A sentinel marker for rejection
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Autoren
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Undine Gerlach
- Charité Universitätsmedizin Berlin, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
| Veröffentlicht: | 24. April 2015 |
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Gliederung
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Introduction: Abdominal wall transplantation (AWT) has revolutionized difficult abdominal closure after intestinal transplantation (ITX). More importantly, the skin of the AWT may serve as an immunological tool that is useful in the differential diagnosis of bowel dysfunction after transplantation.
Material and methods: Between 2012 and 2014, 14 patients (mean age 38.5 ±13.4 years) received AWT from the same donor to complement ITX at the Oxford Transplant Centre. Two doses of alemtuzumab were used for induction therapy (30mg, 6 and 24 after reperfusion) tacrolimus (trough levels 8–12ng/ml) was used for maintenance immunosuppression.
Results: Five recipients had biopsy proven rejection of the skin on their AWT. These patients did not demonstrate concurrent intestinal graft rejection. In contrast, in another 5 patients with bowel dysfunction (fever,diarrhoea), the skin of the AWT remained normal. Intestinal histology was reported as CMV disease.
Conclusion: The skin component of the AWT may serve as a sentinel marker for immunological activity in the host. This is a vital tool for timely prevention of intestinal graft rejection and more importantly the avoidance of overimmunosuppression in cases where bowel dysfunction manifests without the skin component being affected.
