Early Outcome of Different Steroid-Free Regimens in Small Bowel Transplantation: A Large-Animal Study

M. Doni, L. Cobianchi, M. Alessiani, S. Zonta, F. Abbiati, P. Morbini, M. Bardone, M. Mazzilli, J. Viganò, M. De Martino, T. Dominioni, B. Dionigi, M. D. Molinaro, A. Bottazzi, P. Dionigi

Research output: Contribution to journalArticlepeer-review

Abstract

The intestine is a highly immunogenic organ that requires heavy immunosuppression (IS); therefore corticosteroid withdrawal after clinical small bowel transplantation (SBT) has not been standardized. In this study, we compared different immunosuppressive regimens (none with steroid or induction treatment) in a SBT pig model. Large White unrelated piglets were transplanted and divided into four groups as follow: group 1 (n = 3): no IS; group 2 (n = 10): IS with tacrolimus only; group 3 (n = 10): IS with tacrolimus and mycophenolate mofetil; group 4 (n = 5): IS with tacrolimus and rapamycin. Follow-up time was 30 days. All IS drugs were given orally; tacrolimus whole blood levels ranged between 5 and 15 ng/mL in all groups except for group 2 whose tacrolimus whole blood levels ranged between 15 and 25 ng/mL. Group 1 pigs died of graft acute rejection (ACR) after a median of 12 days. Overall survival in groups 2, 3, and 4 at day 30 was 40%, 80%, and 60%, respectively. Biochemical parameters, including glycemia and cholesterol, were into the normal range with no significant differences between groups. At the end of the study, one animal in group 2 and another one in group 4 showed histological signs of moderate to severe ACR. The incidence of infection was higher in group 2 (2.1 episodes/pig) compared to group 3 (1.25) and group 4 (1.6). This large-animal study demonstrates that tacrolimus-based IS without corticosteroids allows, in the early postoperative period (30 days) after SBT, good survival rates without an increased risk in the incidence of rejection.

Original languageEnglish
Pages (from-to)1812-1814
Number of pages3
JournalTransplantation Proceedings
Volume38
Issue number6
DOIs
Publication statusPublished - Jul 2006

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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