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Evolutionary experience with immunosuppression in pediatric intestinal transplantation
Geoffrey J Bond1, George V Mazariegos, Rakesh Sindhi
1Thomas E Starzl Transplantation Institute, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Journal of Pediatric Surgery
|May 4, 2005
Summary
Pediatric intestinal transplantation outcomes have significantly improved with evolving immunosuppression protocols. Newer strategies, including steroid-free monotherapy, enhance graft acceptance and reduce immunosuppression needs, offering hope for complex cases.
Area of Science:
- Pediatric surgery
- Transplant immunology
- Gastroenterology
Background:
- Intestinal transplantation is a standard treatment for irreversible intestinal failure.
- Advances in immunosuppression have been key to improving outcomes.
- This review examines the evolution of immunosuppression in intestinal transplantation.
Purpose of the Study:
- To review the authors' experience with intestinal transplantation.
- To correlate changes in immunosuppression protocols with patient outcomes.
- To highlight the impact of evolving immunosuppression on pediatric intestinal transplantation.
Main Methods:
- Retrospective analysis of 122 children undergoing 129 intestinal allografts (1990-2003).
- Categorization of immunosuppression protocols into three distinct groups based on agents and timing.
- Evaluation of patient/graft survival, rejection rates, infectious diseases, and immunosuppression requirements.
Main Results:
- Overall patient/graft survival improved over time, with the latest protocol (group iii) achieving 100% 1-year survival.
- Acute rejection and infectious diseases (CMV, EBV) were markedly reduced in group (iii).
- Group (iii) demonstrated significantly lower immunosuppression requirements, with many patients on tacrolimus monotherapy, often weaned to spaced doses.
Conclusions:
- Intestinal transplantation has advanced significantly, driven by evolving immunosuppression strategies.
- The latest protocol involving pretreatment/induction and steroid-free monotherapy improves graft acceptance and reduces immunosuppression needs.
- Minimizing immunosuppression, particularly avoiding steroids, offers long-term benefits for pediatric patients, improving hope and outcomes.