AI Article Synopsis

  • Intestinal transplantation (IT) and multivisceral transplantation (MVT) are effective treatments for patients suffering from intestinal failure due to complications from total parenteral nutrition, requiring high levels of immunosuppression to prevent acute cellular rejection (ACR).
  • A review of literature from 2006 to 2022 revealed 14 key studies that highlighted the most effective immunosuppressants for induction and maintenance, identifying thymoglobulin, tacrolimus, and corticosteroids as the main components of therapy.
  • The findings suggest that the optimal immunosuppressive protocol is a triple therapy involving thymoglobulin for induction and a combination of tacrolimus and mycophenolate with corticosteroids for maintenance, with a focus

Article Abstract

Background: Intestinal transplantation (IT) and multivisceral transplantation (MVT) are curative therapies for patients with intestinal failure and severe complications associated with total parenteral nutrition. High levels of immunosuppression are required to prevent acute cellular rejection (ACR) from the bowel. Studies regarding pre-treatment, induction, and post-transplant therapy have improved graft acceptance, reducing immunosuppression doses and infectious complications. However, the low rate of IT and MVT and the small number of specialized centers have resulted in a limited number of evidence-based immunosuppression protocols. We reviewed immunosuppression in IT and MVT to draw useful conclusions regarding the best protocol strategies for the induction, maintenance, and management of ACR.

Methods: A review was performed using the PubMed database. Articles on immunosuppression protocols in IT and MVT that addressed graft rejection, infection, or survival, published between 2006 and 2022, were selected.

Results: A total of 690 articles were selected. Two researchers applied the inclusion and exclusion criteria and selected 14 articles independently. For induction, thymoglobulin, alemtuzumab, and basiliximab are the most frequently used immunosuppressants for induction. Classic maintenance therapy consists of a combination of corticosteroids and tacrolimus. Methylprednisolone with an increased tacrolimus dose is used most frequently to manage ACR. Depending on the receptor response, such as thymoglobulin, infliximab, adalimumab, or bortezomib, other immunosuppressants should be considered.

Conclusions: There have been great advances in IT and TMV immunosuppression. We conclude that the gold standard immunosuppressive protocol is triple therapy, comprising induction with thymoglobulin, maintenance with steroids for a few months, and tacrolimus and mycophenolate therapy. Innovative approaches for treating intestinal rejection episodes with more appropriate drugs, such as infliximab, adalimumab, or bortezomib, are necessary.

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Source
http://dx.doi.org/10.1016/j.transproceed.2023.03.006DOI Listing

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