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Immunosuppression following intestinal transplantation
A R Mueller1, A Pascher, K-P Platz
1Department of Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany. amueller@chirurgie-sh.de
Transplantation Proceedings
|March 31, 2004
Summary
Intestinal transplantation survival rates improved with combined tacrolimus and rapamycin immunosuppression, managing acute rejection effectively. Careful immunosuppression management is crucial, as reduction can trigger severe rejection even late post-transplant.
Area of Science:
- Gastroenterology
- Transplantation Immunology
- Surgical Oncology
Background:
- Acute rejection remains a primary risk in intestinal transplantation.
- Potent immunosuppression is necessary but can lead to complications.
Purpose of the Study:
- To evaluate the efficacy and safety of a specific immunosuppression protocol in adult patients undergoing isolated small intestinal transplantation.
- To assess patient survival, graft function, and complications associated with immunosuppression.
Main Methods:
- 14 adult patients with short bowel syndrome received isolated small intestinal transplants.
- Immunosuppression involved tacrolimus, rapamycin, steroids, and induction therapy (ATG or daclizumab).
- Immune status monitoring included protocol biopsies, cellular/soluble immune parameters, CMV, and EBV markers.
Main Results:
- 71% patient survival (median 26 months); 8 patients are home on enteral nutrition.
- 36% experienced acute rejection; 2 grafts removed, 1 death due to organ failure.
- Infections were common (peritonitis, pneumonia, CMV, EBV), and 2 anastomotic leaks occurred.
Conclusions:
- Combined tacrolimus and rapamycin provide effective control of acute rejection episodes.
- Immunosuppression-related complications, particularly infections, were manageable.
- Reducing immunosuppression, even late post-transplant, can precipitate severe rejection without obvious symptoms.