Introduction: A major complication of a xenograft is the potential for coagulation disorder characterized by thrombocytopenia and bleeding. This complication was rarely seen in our long term xenograft survivors which were promptly monitored for infections by telemetry. Some immunosuppressive agents used for altering the immune response are also involved in triggering coagulopathic episodes. In these experiments we have retrospectively analyzed the onset of coagulopathy in a group of transplants to evaluate its initiating factors.

Methods: Six 8-15Kg specific pathogen free baboons received heterotopic heart transplants from size matched genetically engineered (GE) pigs. The immunosuppression regimen included induction by Anti thymocyte globulin, anti CD20 antibody, cobra venom factor and maintenance regimen included MMF, anti CD40 antibody and steroids. Animals received antibiotics for one-week post transplantation. Unlike our earlier experiments, heart function and recipients body temperature could not be monitored in these animals due to malfunction of the new telemetry system. Rejection was confirmed by echocardiography and histology.

Results: All six animals surgeries were unremarkable and adequate graft function was achieved. The graft survival was 70,>75,>11,>25,9 and >31 days. Only 2 out of 6 animals rejected the graft. In three out of six baboons' infections was not detected in time due to faulty telemetry system. In these three baboons' severe thrombocytopenia leading to coagulopathy was observed after baboons began to demonstrate signs of lethargy and loss of appetite. Blood culture in all three animals were positive for bacterial growth. An elevated WBC count also coincided with the onset of platelet consumption and bleeding.

Conclusion: In this series of cardiac xenotransplantations, we observed a close association of severe sepsis and coagulopathy. In our earlier experiments, due to very accurate telemetry function, we detected temperature spike at a very early stage of infection and were able to avoid sepsis and resulting coagulation disorder in almost all cases by prompt institution of antibiotic treatment. However, lack of our such ability in this cohort elaborated the importance of early detection of infection and also reliably established infection as the triggering factor for the coagulopathy.

CITATION INFORMATION: Mohiuddin M, Singh A, Chan J, Corcoran P, Lewis B, Thomas M, Ayares D, Horvath K. Lack of Xenograft Recipient Monitoring by Telemetry Lets Infection Go Unchecked and Trigger Coagulopathy. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress