2011 - ISBTS 2011 Symposium


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Oral Communications 12: Sensitization

14.241 - Induction therapy with thymoglobulin in immunologically high risk intestinal transplant recipients

Presenter: Jason, Hawksworth, Washington DC, United States
Authors: Jason Hawksworth1, Eddie Island1, Cal Matsumoto1, Juan Francisco Guerra1, Lee Cummings1, Kimberly Christensen1, Sandra Rosen-Bronson1, Cheryl Little1, Kirti Shetty1, Jaqueline Laurin1, Rohit Satoskar1, Stuart Kaufman1, Thomas Fishbein1

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Induction therapy with thymoglobulin in immunologically high risk intestinal transplant recipients

Jason Hawksworth, Eddie Island, Cal Matsumoto, Juan Francisco Guerra, Lee Cummings, Kimberly Christensen, Sandra Rosen-Bronson, Cheryl Little, Kirti Shetty, Jaqueline Laurin, Rohit Satoskar, Stuart Kaufman, Thomas Fishbein

Georgetown University Hospital, Washington, DC, United States

Intestinal transplantation (ITx) has advanced rapidly in the last decade and is currently a viable therapy for select patients with intestinal failure. However, the immunologic barrier to successful ITx is formidable and acute rejection continues to be a significant source of morbidity and mortality. In addition, the optimal induction therapy for immunologically high risk intestinal transplant recipients remains elusive.

Methods: Retrospective analysis of all isolated ITx performed in at our institution from November 2003 to November 2010. High immunologic risk was defined as NOD mutant, PRA >20%, or a positive cross match (XM). Standard immunosuppression (IS) consisted of IL2 blockade induction with maintenance IS of tacrolimus, sirolimus, and prednisone. Select high risk recipients received thymoglobulin induction followed by standard maintenance IS. Low risk recipients generally received thymoglobulin induction when therapeutic tacrolimus levels could not be achieved post transplant.

Results: 126 ITx were performed in 123 recipients with a mean follow up of 44 months. There were 58 (46%) immunologically high risk recipients, including 33 (26%) NOD mutant recipients, 28 (22%) with PRA >20%, and 8 (6%) with positive XM; 11 (9%) recipients had >1 immunologic risk factor. 3 year freedom from rejection (FFR) was significantly decreased in the immunologically high risk group compared to the low risk group, (51.7% versus 80.6%, p=0.001) and there was a trend towards decreased survival in the high risk group compared to the low risk group, (60.3% versus 72.1%, p=0.176). Thymoglobulin induction was administered to 26/58 (45%) of the high risk and 11/67 (16%) of the low risk recipients, p=0.001. There was no difference in 3 year FFR and mortality in high risk recipients that received thymoglobulin compared to high risk recipients that received IL2 blockade (46.2% versus 56.3%, p=0.430 and 57.7% versus 62.5%, p=0.604, respectively). In low risk recipients that received thymoglobulin there was no difference in 3 year FFR and a trend towards decreased 3 year survival compared to low risk recipients that received IL2 blockade (81.8% versus 72.7%, p=0.486 and 54.5% versus 75.0%, p=0.132, respectively).

Conclusions: Immunologically high risk intestinal transplant recipients have increased 3 year acute rejection and mortality rates compared to low risk recipients. Thymoglobulin induction therapy does not reduce this risk in high risk recipients and may increase mortality in low risk recipients.


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