REPETITIVE INFECTIONS TRIGGERING UNCONTROLLED GRAFT REJECTION AFTER INTESTINAL TRANSPLANTATION

Results: Pre-transplant DSA MFI was 5,398, and the patient underwent prior desensitization with plasmapheresis and IVIG.Induction therapy with ATG, rituximab, and methylprednisolone was given.Following biopsy-confirmed AMR on day 14 posttransplant, he received pulsed steroids, ATG, weekly plasmapheresis, rituximab, IVIG, and eculizumab.DSA MFI at this time peaked at 16,694.Initial histology showed severe rejection throughout the graft with crypt loss, no viable villi and strong C4d staining (80%).After 5 weeks findings improved, DSAs declined (MFI 3,500), and enteral feeds resumed at 7 weeks.Figures a, b and c demonstrate endoscopic appearances at 2-, 4-and 6-weeks post-transplant.Conclusions: We report a successful paediatric redo small bowel and colon transplant in a highly sensitised patient.Despite severe AMR, early, aggressive management led to graft recovery.Two years post-transplant, the patient remains well, attending school, and with full graft function.This case emphasis the need for vigilance and prompt management of complications following intestinal transplant.