2011 - ISBTS 2011 Symposium


Oral Communications 16: Long Term Outcomes

21.325 - Moderate-severe and chronic rejection after intestinal/multivisceral transplant in induction era: Bologna 11 years experience on adults

Presenter: Augusto, Lauro, Bologna, Italy
Authors: Augusto Lauro1, Chiara Zanfi1, Sara Pellegrini1, Fausto Catena1, Loris Pironi1, Antonio Pinna1


325
Moderate-severe and chronic rejection after intestinal/multivisceral transplant in induction era: Bologna 11 years experience on adults

Augusto Lauro, Chiara Zanfi, Sara Pellegrini, Fausto Catena, Loris Pironi, Antonio Pinna

S. Orsola Hospital - Liver and Multiorgan Transplant Center, Bologna, Italy

Aim: To evaluate outcome of adult patients treated for rejection after intestinal transplantation.

Subjects and Methods: Over last 11 years we performed 46 intestinal/multivisceral transplants, 22 recipients are alive: 32 recipients underwent Alemtuzumab induction (with FK), 12 Daclizumab(with FK plus steroids), 2 Thymoglobulin (with FK). On 11 recipients we applied new protocol, administering 15 mg of Campath (day 0 and 7), instead conventional 4 doses (each 15 mg) usually utilized. We divided recipients in two groups: 1) patients with indeterminate, mild, vascular rejection-requiring no or minimal increased immunosuppression; 2) patients with moderate, severe, chronic rejection-requiring relevant increased immunosuppression.

Results: Group 1 - 30 patients (65.2% of transplants) experiencing 65 episodes (2.1/patient) of indeterminate, mild, vascular rejections with no or minimal increased immunosuppression: 16 recipients (53.3%) are alive, two require TPN with oral feeding. The only re-transplant is alive. Notably first rejection was 1 month after transplant on 13 recipients (43.3%). Group 2 - 16 patients (34.7% of transplants) experiencing 63 episodes (3.9/patient) of  indeterminate, mild, vascular rejections and 22 episodes (1.3/patient) of  moderate, severe , chronic rejections: in last cases we added steroids (5 recipients) ,OKT3 (5), Thymoglobulin (4), Alemtuzumab (2), Infliximab (2). Seven patients (43.7%) are alive, one requiring TPN with oral feeding: these recipients were treated by steroids (3), OKT3 (3) and Alemtuzumab (1).The only re-transplant is dead. Notably first rejection was 1 month after transplant on 13 recipients (81.1%). Regarding new Alemtuzumab protocol, eight patients out of 11 are alive: 1 died for tumor recurrence, the other two for infection after Thymoglobulin, Campath and Infliximab.

Conclusions: Presence of earlier, higher number and worse degree of rejections causes higher mortality in adults, even if induction reduced  mortality, allowing  most of them to be treated by minimal immunosuppression and, if increased immunosuppression, to rescue percentage of them. 


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