| Preliminary experience with alemtuzumab induction therapy combined with maintenance low-dose tacrolimus monotherapy in small-bowel transplantation in China. | |
| | |
MedLine Citation:
|
PMID: 20172275 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
INTRODUCTION: The goal of combining alemtuzumab induction therapy with low-dose tacrolimus monotherapy in small-bowel transplantation (SBTx) is to enable improved graft acceptance without immunologic unresponsiveness caused by stronger immunosuppression regimens. Herein, we report preliminary experience using this protocol in 5 patients who underwent SBTx in China. METHODS: Patients received methylprednisolone sodium succinate (Solu-Medrol), 1 g, followed by alemtuzumab infusion, 30 mg, during SBTx and another gram of prednisolone before reperfusion. Tacrolimus monotherapy without steroid was used for maintenance immunosuppression. Tacrolimus trough levels were 10 to 15 ng/dL during the first 3 months, and weaned to 5 to 10 ng/mL after 3 months. RESULTS: Three recipients have survived for longer than 1 year; 1 patient is currently alive at 9 months, and another at 5 months post-SBTx. Grafts in these 5 recipients achieved excellent function, and in all patients, total parenteral nutrition was discontinued at 2 to 3 weeks postoperatively and normal oral intake was resumed. One recipient died at 13 months post-SBTx of severe rejection; the condition of the other 4 recipients who were still alive was good. Pathologic analysis of ileoscopic biopsy specimens revealed 4 episodes of indeterminate to mild acute cellular rejection (ACR) at 1 to 3 months, 3 episodes of indeterminate to mild ACR at 4 to 6 months, 3 episodes of moderate ACR at 7 to 12 months, and 1 episode of severe ACR at 13 months. All episodes of indeterminate to moderate ACR were totally resolved; only treatment of severe ACR failed. One patient experienced an episode of invasive fungal infection and another episode of cytomegaloviral infection, with total recovery after treatment. CONCLUSIONS: Our preliminary experience in these 5 cases showed that the protocol combining alemtuzumab induction therapy with low-dose tacrolimus monotherapy without maintenance steroid therapy past-SBTx can effectively control rejection with excellent graft function. Nevertheless, close surveillance of ACR should be still performed after 6 months. |
| | |
Authors:
|
L Yuan-Xin; L Ning; L You-Sheng; N Xiao-Dong; L Ming; W Jian; L Jie-Shou |
Related Documents
:
|
18434855 - Long-term use of topical tacrolimus (fk506) in high-risk penetrating keratoplasty. 22991015 - The effects of biocompatible compared with standard peritoneal dialysis solutions on pe... 11054005 - Effective treatment with topical cyclosporin a of a patient with cogan syndrome. 19016105 - Refractory linear iga bullous dermatosis successfully treated with mycophenolate sodium. 8868355 - Gastric bacterial overgrowth accompanies profound acid suppression. 12827065 - Anticoagulants for nonvalvular atrial fibrillation (nvaf)--drug review. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Transplantation proceedings Volume: 42 ISSN: 1873-2623 ISO Abbreviation: Transplant. Proc. Publication Date: 2010 Jan-Feb |
Date Detail:
|
Created Date: 2010-02-22 Completed Date: 2010-06-03 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
|
Languages: eng Pagination: 29-34 Citation Subset: IM |
Affiliation:
|
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. liyuanxin1966@yahoo.com.cn |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Anti-Bacterial Agents / therapeutic use Antibodies, Monoclonal / therapeutic use* Antibodies, Neoplasm / therapeutic use* Bacterial Translocation / drug effects China Drug Therapy, Combination Enteral Nutrition Female Graft Rejection / prevention & control Humans Immunosuppressive Agents Intestine, Small / transplantation* Male Methylprednisolone / therapeutic use Parenteral Nutrition, Total Survival Analysis Tacrolimus / therapeutic use* Young Adult |
| Chemical | |
Reg. No./Substance:
|
0/Anti-Bacterial Agents; 0/Antibodies, Monoclonal; 0/Antibodies, Neoplasm; 0/Immunosuppressive Agents; 0/alemtuzumab; 109581-93-3/Tacrolimus; 83-43-2/Methylprednisolone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Sepsis and Its Etiology Among Hospitalized Children Less Than 1 Year of Age With Intestinal Failure ...
Next Document: Daclizumab and Alemtuzumab as Induction Agents in Adult Intestinal and Multivisceral Transplantation...