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Intestinal transplantation under tacrolimus monotherapy after perioperative lymphoid depletion with rabbit anti-thymocyte globulin (thymoglobulin®)

Reyes, J and Mazariegos, GV and Abu-Elmagd, K and Macedo, C and Bond, GJ and Murase, N and Peters, J and Sindhi, R and Starzl, TE (2005) Intestinal transplantation under tacrolimus monotherapy after perioperative lymphoid depletion with rabbit anti-thymocyte globulin (thymoglobulin®). American Journal of Transplantation, 5 (6). 1430 - 1436. ISSN 1600-6135

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Abstract

Modifications in the timing and dosage of immunosuppression can ameliorate the morbidity and mortality that has prevented widespread use of intestinal transplantation (ITx) in children. Thirty-six patients receiving ITx, aged 5 months to 20 years were given 2-3 mg(kg of rabbit anti-thymocyte globulin (rATG, thymoglobulin®) just before ITx, and 2-3 mg(kg post-operatively (total 5 mg(kg). Twice daily doses of tacrolimus (TAC) were begun enterally within 24 h after graft reperfusion with reduction of dose quantity or frequency after 3 months. Prednisone or other agents were given to treat breakthrough rejection. After 8-28 months follow-up (mean 15.8 ± 5.3), 1- and 2-year patient and graft survival is 100% and 94%, respectively. Despite a 44% incidence of acute rejection in the first month, 16 of the 34 (47%) survivors are on TAC (n = 14) or sirolimus (n = 2) monotherapy; 15 receive TAC plus low dose prednisone; one each receive TAC plus sirolimus, TAC plus azathioprine and TAC plus sirolimus and prednisone. There was a low incidence of immunosuppression-related complications. This strategy of immunosuppression minimized maintenance TAC exposure, facilitated the long-term control of rejection, decreased the incidence of opportunistic infections, and resulted in a high rate of patient and graft survival. Copyright © Blackwell Munksgaard 2005.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Reyes, J
Mazariegos, GVmazarieg@pitt.eduMAZARIEG
Abu-Elmagd, K
Macedo, C
Bond, GJ
Murase, N
Peters, J
Sindhi, Rrsindhi@pitt.eduRSINDHI
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 June 2005
Date Type: Publication
Journal or Publication Title: American Journal of Transplantation
Volume: 5
Number: 6
Page Range: 1430 - 1436
DOI or Unique Handle: 10.1111/j.1600-6143.2005.00874.x
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 1600-6135
Other ID: uls-drl:31735062121185, Starzl CV No. 2210
Date Deposited: 08 Apr 2010 17:38
Last Modified: 13 Oct 2017 22:56
URI: http://d-scholarship.pitt.edu/id/eprint/5596

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