Induction and Maintenance Immunosuppression in Intestinal Transplantation

2018 ◽  
pp. 653-667
Author(s):  
Georgi Atanasov ◽  
Andreas Pascher
Keyword(s):  
Intestinal Transplantation ◽  
Maintenance Immunosuppression

Immunosuppressant Strategies for Intestinal Transplantation: A Review of a Tolerogenic Regimen

2005 ◽  
Vol 15 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Bridget Flynn ◽  
Beverly Kosmach Park ◽  
Geoffrey Bond ◽  
William McGhee ◽  
George Mazariegos ◽  
...  
Keyword(s):  
Intestinal Failure ◽  
Surgical Techniques ◽  
Intestinal Transplantation ◽  
Standard Of Care ◽  
Effective Control ◽  
Term Survival ◽  
Innovative Strategies ◽  
Maintenance Immunosuppression ◽  
Life Threatening

Intestinal, combined liver-intestinal, and multivisceral transplantation are now considered the standard of care for children and adults with permanent intestinal failure. Early attempts at intestinal transplantation were discouraging because of the high incidence of technical complications, rejection, and infection. Advances in the field of transplantation, including the introduction of tacrolimus, improved surgical techniques, and improvements in postoperative care, have led to a renewed interest in intestinal transplantation since 1990. The most significant achievement, however, has been the effective control of rejection and life-threatening infections. This article focuses on the experience to date of innovative strategies that induce lymphocyte depletion and reduction in the incidence of rejection. In this setting, low-maintenance immunosuppression is clinically achievable with an acceptable rate of allograft rejection. Subsequently, the long-term complications of immunosuppression are significantly reduced with achievement of better long-term survival, and an overall improvement in the quality of life.

Intestinal transplantation

2002 ◽  
Vol 13 (3) ◽  
pp. 231-236
Author(s):  
Wendy J. Grant ◽  
Jean F. Botha ◽  
Alan N. Langnas
Keyword(s):  
Intestinal Transplantation

A novel technique for large lateral enterocutaneous fistula management after intestinal transplantation

2021 ◽  
Author(s):  
Agustina R Oliva ◽  
Paula Violo Gonzalez ◽  
Luciana Lerendegui ◽  
Rodrigo Sanchez Clariá ◽  
Juan Moldes ◽  
...  
Keyword(s):  
Enterocutaneous Fistula ◽  
Intestinal Transplantation ◽  
Novel Technique

scholarly journals Successful long-term management of recurrent focal segmental glomerulosclerosis after kidney transplantation with costimulation blockade

2020 ◽  
Author(s):  
Thomas Mühlbacher ◽  
Kerstin Amann ◽  
Moritz Mahling ◽  
Silvio Nadalin ◽  
Nils Heyne ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Focal Segmental Glomerulosclerosis ◽  
Costimulation Blockade ◽  
Segmental Glomerulosclerosis ◽  
Remission Maintenance ◽  
Maintenance Immunosuppression ◽  
Therapeutic Concepts ◽  
Allograft Outcome

Abstract Recurrence of primary focal segmental glomerulosclerosis (FSGS) occurs in up to 50% of patients after kidney transplantation and is associated with poor allograft outcome. Novel therapeutic concepts directly target podocyte function via B7-1 with inconsistent response. We present the case of a 19 yr. old patient with recurrent primary FSGS early after living donor kidney transplantation. Plasmapheresis and rituximab did not induce remission. Repetitive abatacept administration was able to achieve partial remission. Maintenance immunosuppression was subsequently switched to a belatacept-based CNI-free immunosuppression, resulting in sustained complete remission with excellent allograft function throughout a follow-up of more than 56 months.

Pediatric intestinal transplantation

2017 ◽  
Vol 26 (4) ◽  
pp. 241-249 ◽  
Author(s):  
Kyle A. Soltys ◽  
Geoff Bond ◽  
Rakesh Sindhi ◽  
Sara K. Rassmussen ◽  
Armando Ganoza ◽  
...  
Keyword(s):  
Intestinal Transplantation

scholarly journals Combined low-dose everolimus and low-dose tacrolimus after Alemtuzumab induction therapy: a randomized prospective trial in lung transplantation

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alberto Benazzo ◽  
Ara Cho ◽  
Anna Nechay ◽  
Stefan Schwarz ◽  
Florian Frommlet ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Lung Transplantation ◽  
Kidney Function ◽  
Induction Therapy ◽  
Low Dose ◽  
Prospective Trial ◽  
Control Group ◽  
Long Term Outcomes ◽  
Maintenance Immunosuppression

Abstract Background Long-term outcomes of lung transplantation are severely affected by comorbidities and development of chronic rejection. Among the comorbidities, kidney insufficiency is one of the most frequent and it is mainly caused by the cumulative effect of calcineurin inhibitors (CNIs). Currently, the most used immunosuppression protocols worldwide include induction therapy and a triple-drug maintenance immunosuppression, with one calcineurin inhibitor, one anti-proliferative drug, and steroids. Our center has pioneered the use of alemtuzumab as induction therapy, showing promising results in terms of short- and long-term outcomes. The use of alemtuzumab followed by a low-dose double drug maintenance immunosuppression, in fact, led to better kidney function along with excellent results in terms of acute rejection, chronic lung allograft dysfunction, and survival (Benazzo et al., PLoS One 14(1):e0210443, 2019). The hypothesis driving the proposed clinical trial is that de novo introduction of low-dose everolimus early after transplantation could further improve kidney function via a further reduction of tacrolimus. Based on evidences from kidney transplantation, moreover, alemtuzumab induction therapy followed by a low-dose everolimus and low-dose tacrolimus may have a permissive action on regulatory immune cells thus stimulating allograft acceptance. Methods A randomized prospective clinical trial has been set up to answer the research hypothesis. One hundred ten patients will be randomized in two groups. Treatment group will receive the new maintenance immunosuppression protocol based on low-dose tacrolimus and low-dose everolimus and the control group will receive our standard immunosuppression protocol. Both groups will receive alemtuzumab induction therapy. The primary endpoint of the study is to analyze the effect of the new low-dose immunosuppression protocol on kidney function in terms of eGFR change. The study will have a duration of 24 months from the time of randomization. Immunomodulatory status of the patients will be assessed with flow cytometry and gene expression analysis. Discussion For the first time in the field of lung transplantation, this trial proposes the combined use of significantly reduced tacrolimus and everolimus after alemtuzumab induction. The new protocol may have a twofold advantage: (1) further reduction of nephrotoxic tacrolimus and (2) permissive influence on regulatory cells development with further reduction of rejection episodes. Trial registration EUDRACT Nr 2018-001680-24. Registered on 15 May 2018

Re-evaluating Blood Markers as Predictors of Outcome in Multivisceral and Intestinal Transplantation

2021 ◽  
Vol 53 (2) ◽  
pp. 696-704
Author(s):  
Donna Cheung ◽  
Jennifer Garcia ◽  
Thiago Beduschi ◽  
Amber Langshaw ◽  
Kristopher Arheart ◽  
...  
Keyword(s):  
Intestinal Transplantation ◽  
Predictors Of Outcome
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