Gentilini María Virginia, Perez-Illidge Luis, Pedraza Néstor, Nemirovsky Sergio Iván, Fernandez María Florencia, Ramisch Diego, Solar Héctor, Rumbo Martín, Rumbo Carolina, Gondolesi Gabriel E
From the Unidad de Soporte Nutricional, Rehabilitaciín y Trasplante Intestinal, Hospital Universitario Fundaciín Favaloro, Buenos Aires, Argentina.
From the Laboratorio de Investigaciín Traslacional e Inmunología Asociada al Trasplante, Instituto de Medicina Traslacional, Inmunología, Trasplante y Bioingenería (IMeTTyB-CONICET), Universidad Favaloro, Buenos Aires, Argentina.
Exp Clin Transplant. 2022 Dec;20(12):1105-1113. doi: 10.6002/ect.2022.0359.
Immunosuppressive strategies for intestinal transplant have changed over time. However, specific intestinal transplant-oriented protocols and reports on long-term maintenance regimens are scarce. Our objective was to evaluate the impact of 2 different initial immunosuppressive protocols based on thymoglobulin (group A) and basiliximab (anti-interleukin 2 antibody) (group B) and of changes to maintenance immunosuppression over long-term follow-up in intestinal transplant recipients.
We performed a retrospective analysis of a prospectively established protocol for intestinal transplant immunosuppression, conducted between May 2006 and December 2020. We analyzed 51 intestinal transplant recipients, with 6 patients excluded because of early death or graft loss. Acute cellular rejection frequency and grade, number of acute cellular rejection episodes, time to the first acute cellular rejection episode, response to treatment, number of patients who progressed to chronic allograft rejection, kidney function, infections, incidence of posttransplant lymphoproliferative disorder and graft-versus-host disease, and patient and graft survival were analyzed.
In the study groups, there were 87 acute cellular rejection episodes in 45 patients (33 in group A and 54 in group B). We found degree of acute cellular rejection to be mild in 45 patients, moderate in 18, and severe in 24 (not significant between groups). Our comparison of induction therapy (thymoglobulin [group A] vs interleukin 2 antibody [group B]) did not show any statistical difference during clinical followup. Long-term review showed that all patients were on tacrolimus. Five-year patient and graft survival rates were 62% and 45% for group A and 54% and 46% for group B, respectively (not significant).
Long-term patient and graft outcomes reflected the use of an individualized follow-up with adjustments and changes in immunosuppressive medications according to the patient's clinical course and complications rather than based on the induction immunosuppressive protocol used.
肠道移植的免疫抑制策略随时间而变化。然而，针对肠道移植的特定方案以及关于长期维持方案的报告却很稀少。我们的目的是评估基于抗胸腺细胞球蛋白（A组）和巴利昔单抗（抗白细胞介素2抗体）（B组）的两种不同初始免疫抑制方案，以及在肠道移植受者长期随访期间维持免疫抑制变化的影响。
我们对2006年5月至2020年12月期间前瞻性制定的肠道移植免疫抑制方案进行了回顾性分析。我们分析了51例肠道移植受者，其中6例因早期死亡或移植物丢失而被排除。分析了急性细胞排斥反应的频率和分级、急性细胞排斥反应发作次数、首次急性细胞排斥反应发作时间、治疗反应、进展为慢性移植物排斥反应的患者数量、肾功能、感染情况、移植后淋巴细胞增生性疾病和移植物抗宿主病的发生率以及患者和移植物存活率。
在研究组中，45例患者发生了87次急性细胞排斥反应（A组33次，B组54次）。我们发现45例患者的急性细胞排斥反应程度为轻度，18例为中度，24例为重度（两组之间无显著差异）。我们对诱导治疗（抗胸腺细胞球蛋白[A组]与白细胞介素2抗体[B组]）的比较在临床随访期间未显示出任何统计学差异。长期随访显示所有患者均使用他克莫司。A组的5年患者和移植物存活率分别为62%和45%，B组分别为54%和46%（无显著差异）。
长期的患者和移植物结局反映了根据患者的临床病程和并发症，而不是基于所使用的诱导免疫抑制方案，对免疫抑制药物进行调整和改变的个体化随访的应用。
