Complete freedom from rejection after intestinal transplantation using a new tolerogenic protocol combined with low immunosuppression

Transplantation
Jacques PirenneMark Waer

Abstract

Intestinal transplantation (Itx) remains the most difficult form of transplantation. This is due to the high immunogenicity of the bowel that currently obligates Itx patients to heavy immunosuppression, which causes infection, posttransplant lymphoproliferative disease (PTLD), and drug toxicity. Wider application of Itx depends on the development of tolerogenic strategies to promote engraftment while reducing the need for immunosuppression. We applied a strategy to clinical Itx that combines intraportal donor-specific blood transfusion with a deliberately low immunosuppression protocol (no high-dose steroids; lower tacrolimus level). A 55-year-old patient received a combined liver/Itx. Donor-specific whole blood was taken from the donor during procurement and transfused in the recipient portal vein after graft reperfusion. For induction immunosuppression, no intravenous bolus of steroids was given; only two doses of anti-interleukin 2 receptor antibody were administered. The patient received posttransplantation maintenance immunosuppression with lower tacrolimus levels than average (15 ng/ml first month; 5-10 ng/ml thereafter), low-dose azathioprine (1 mg/kg first to third months; 0.5 mg/kg thereafter), and low-dose steroids (M...Continue Reading

References

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Citations

Dec 4, 2003·Best Practice & Research. Clinical Gastroenterology·Enrico BenedettiHerand Abcarian
Apr 9, 2005·European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes·J A Diaz-Peromingo, A Gonzalez-Quintela
Apr 18, 2009·Current Opinion in Organ Transplantation·Jacques Pirenne, Masaru Kawai
May 13, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Jorge ReyesThomas E Starzl
Sep 24, 2004·Transplant Immunology·Jacques Pirenne, Masaru Kawai
Dec 17, 2014·Transplantation Proceedings·H PanM Michallet

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