Impacts of donor-specific anti-HLA antibodies and antibody-mediated rejection on outcomes after intestinal transplantation in children.

AMR is a risk factor for graft failure after SBTx. We studied impact of DSAs and AMR in 22 children transplanted between 2008 and 2012 (11 isolated SBTx, 10 liver inclusive Tx, and one modified multivisceral Tx). Three patients never developed DSA, but DSAs were found in seven in the pre-Tx period and de novo post-Tx in 19 children. Pathology revealed cellular rejection (15/19), with vascular changes and C4d+. Patients were treated with IV immunoglobulins, plasmapheresis, and steroids. Rescue therapy included antithymocyte globulins, rituximab, eculizumab, and bortezomib. Pathology and graft function normalized in 13 patients, graft loss occurred in two, and death in seven. At the end of the follow-up, 15 children were alive (68%), 13 with functioning graft (59%). Prognosis factors for poor outcome after Tx were the presence of symptoms at AMR suspicion (P +.033). DSAs were often found following SBTx, mostly de novo. Resistant ACR or severe AMR is still difficult to differentiate, with a high need for immunosuppression in both. DSAs may precede development of severe disease and pathology features on the graft: relationship and correlation need to be better investigated with larger groups before and after Tx.

Surface wave energy absorption by a partially submerged bio-inspired canopy.

Aquatic plants are known to protect coastlines and riverbeds from erosion by damping waves and fluid flow. These flexible structures absorb the fluid-borne energy of an incoming fluid by deforming mechanically. In this paper we focus on the mechanisms involved in these fluid-elasticity interactions, as an efficient energy harvesting system, using an experimental canopy model in a wave tank. We study an array of partially-submerged flexible structures that are subjected to the action of a surface wave field, investigating in particular the role of spacing between the elements of the array on the ability of our system to absorb energy from the flow. The energy absorption potential of the canopy model is examined using global wave height measurements for the wave field and local measurements of the elastic energy based on the kinematics of each element of the canopy. We study different canopy arrays and show in particular that flexibility improves wave damping by around 40%, for which half is potentially harvestable.