Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report
Background: Acute cellular rejection (ACR) is a well-recognised cause of graft failure in intestinal transplant (ITx) recipients. Management of ACR is with intravenous (IV) steroids, increased immunosuppression and T-cell depleting therapies. Use of alternative therapies such as anti-tumour necrosis...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | Intestinal Failure |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950456224000253 |
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| author | Katrina Tan Elizabeth Low Graham Starkey Khashayar Asadi Adam Testro Darren Wong |
| author_facet | Katrina Tan Elizabeth Low Graham Starkey Khashayar Asadi Adam Testro Darren Wong |
| author_sort | Katrina Tan |
| collection | DOAJ |
| description | Background: Acute cellular rejection (ACR) is a well-recognised cause of graft failure in intestinal transplant (ITx) recipients. Management of ACR is with intravenous (IV) steroids, increased immunosuppression and T-cell depleting therapies. Use of alternative therapies such as anti-tumour necrosis factor alpha (TNFα) agents in steroid-refractory cases should be considered. Case report: A 44-year-old male who received a combined liver-intestinal transplant with ACR unresponsive to IV steroids and anti-thymocyte globulin (ATG), which evolved into chronic rejection (CR). His symptoms were predominantly obstructive with endoscopic similarities to stricturing Crohn’s disease. He was successfully managed with infliximab followed by segmental graft resection. With ongoing maintenance infliximab he has remained clinically well with enteral autonomy and no recurrence of rejection. Conclusion: Alternative therapies for management of severe ACR unresponsive to traditional management should be considered in ITx patients. There are increasing numbers of case reports to support the use of anti-TNFα therapy in these cases. |
| format | Article |
| id | doaj-art-96765e64ab6c4cffad236b093ba04f41 |
| institution | OA Journals |
| issn | 2950-4562 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Intestinal Failure |
| spelling | doaj-art-96765e64ab6c4cffad236b093ba04f412025-08-20T01:49:31ZengElsevierIntestinal Failure2950-45622024-04-01210002510.1016/j.intf.2024.100025Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case reportKatrina Tan0Elizabeth Low1Graham Starkey2Khashayar Asadi3Adam Testro4Darren Wong5Australian Intestinal Transplant Service, Austin Health, Australia; Australian Centre for Transplant Excellence and Research, Australia; Corresponding author at: Australian Intestinal Transplant Service, Austin Health, Australia.Australian Intestinal Transplant Service, Austin Health, Australia; Australian Centre for Transplant Excellence and Research, AustraliaAustralian Intestinal Transplant Service, Austin Health, Australia; Australian Centre for Transplant Excellence and Research, Australia; Department of Medicine, University of Melbourne, AustraliaAustralian Intestinal Transplant Service, Austin Health, Australia; Australian Centre for Transplant Excellence and Research, AustraliaAustralian Intestinal Transplant Service, Austin Health, Australia; Australian Centre for Transplant Excellence and Research, Australia; Department of Medicine, University of Melbourne, AustraliaAustralian Intestinal Transplant Service, Austin Health, Australia; Australian Centre for Transplant Excellence and Research, Australia; Department of Medicine, University of Melbourne, AustraliaBackground: Acute cellular rejection (ACR) is a well-recognised cause of graft failure in intestinal transplant (ITx) recipients. Management of ACR is with intravenous (IV) steroids, increased immunosuppression and T-cell depleting therapies. Use of alternative therapies such as anti-tumour necrosis factor alpha (TNFα) agents in steroid-refractory cases should be considered. Case report: A 44-year-old male who received a combined liver-intestinal transplant with ACR unresponsive to IV steroids and anti-thymocyte globulin (ATG), which evolved into chronic rejection (CR). His symptoms were predominantly obstructive with endoscopic similarities to stricturing Crohn’s disease. He was successfully managed with infliximab followed by segmental graft resection. With ongoing maintenance infliximab he has remained clinically well with enteral autonomy and no recurrence of rejection. Conclusion: Alternative therapies for management of severe ACR unresponsive to traditional management should be considered in ITx patients. There are increasing numbers of case reports to support the use of anti-TNFα therapy in these cases.http://www.sciencedirect.com/science/article/pii/S2950456224000253Intestinal transplantAcute cellular rejectionChronic rejectionInfliximab |
| spellingShingle | Katrina Tan Elizabeth Low Graham Starkey Khashayar Asadi Adam Testro Darren Wong Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report Intestinal Failure Intestinal transplant Acute cellular rejection Chronic rejection Infliximab |
| title | Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report |
| title_full | Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report |
| title_fullStr | Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report |
| title_full_unstemmed | Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report |
| title_short | Combination of anti-TNFα therapy and surgical resection for severe chronic intestinal rejection: A case report |
| title_sort | combination of anti tnfα therapy and surgical resection for severe chronic intestinal rejection a case report |
| topic | Intestinal transplant Acute cellular rejection Chronic rejection Infliximab |
| url | http://www.sciencedirect.com/science/article/pii/S2950456224000253 |
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