Small intestine transplant immunologic risk assessment: More data is needed

Background: Intestinal transplantation (IT) remains the only treatment modality for patients with irreversible intestinal failure who cannot be maintained on chronic parenteral nutrition. Multiple reports have demonstrated an association between donor-specific antibodies (DSA) in IT graft rejection, however these studies have largely been single-center analyses. The goal of this study was to examine the available immunological data from the International Intestinal Transplant Registry (IITR) and evaluate the association with rejection. Materials and methods: Demographic, outcomes, and serologic HLA data from donor/recipient pairs was obtained from the IITR. Outcomes including rejection, graft survival, and patient survival were analyzed based on age, DSA reporting, and molecular HLA mismatch. Eplet mismatch analysis was performed using HLAMatchmaker. Results: Our analysis revealed significant limitations in the granularity of data contained in the IITR. Conclusion: The IITR database is a promising option to perform a multicenter analysis of IT outcomes, but there are limitations in the data to allow a thorough immunologic examination.