Immunosuppression Protocols in Intestinal and Multivisceral Transplantation-A Literature Review

Area of Science:

• Transplantation Immunology
• Gastroenterology
• Immunosuppression Therapy

Background:

• Intestinal transplantation (IT) and multivisceral transplantation (MVT) offer curative potential for intestinal failure.
• High-dose immunosuppression is vital to prevent acute cellular rejection (ACR) in IT and MVT.
• Limited evidence-based protocols exist due to low transplant rates and few specialized centers.

Purpose of the Study:

• To review current immunosuppression strategies in IT and MVT.
• To identify optimal protocols for induction, maintenance, and ACR management.
• To draw conclusions on effective immunosuppression in intestinal and multivisceral transplantation.

Main Methods:

• Systematic review of PubMed-indexed articles published between 2006 and 2022.
• Focused on immunosuppression protocols for IT and MVT, addressing rejection, infection, and survival.
• Independent selection of 14 relevant articles by two researchers.

Main Results:

• Common induction agents include thymoglobulin, alemtuzumab, and basiliximab.
• Standard maintenance involves corticosteroids and tacrolimus.
• Methylprednisolone with increased tacrolimus is frequent for ACR; other agents like infliximab may be considered.

Conclusions:

• Significant advancements have been made in IT and MVT immunosuppression.
• Triple therapy (thymoglobulin induction, short-term steroids, tacrolimus/mycophenolate maintenance) is the gold standard.
• Novel agents (infliximab, adalimumab, bortezomib) are needed for effective intestinal rejection treatment.