Impact of induction therapy on bacterial infections and long-term outcome in adult intestinal and multivisceral transplantation: A comparison of two different induction protocols: Daclizumab vs. alemtuzumab

Takuya Kimura, Augusto Lauro, Matteo Cescon, Chiara Zanfi, Alessandro Dazzi, Giorgio Ercolani, Gian Luca Grazi, Marco Vivarelli, Matteo Ravaioli, Massimo Del Gaudio, Alessandro Cucchetti, Matteo Zanello, Giuliano Labarba, Loris Pironi, Tiziana Lazzarotto, Antonio Daniele Pinna

Research output: Contribution to journalArticle

Abstract

Induction therapy with daclizumab or alemtuzumab has been recently introduced for intestinal transplantation; however, the impact of such induction therapy on bacterial infections remains to be clarified. The purpose of this study was to evaluate the impact of induction therapy on the incidence of bacterial infections and long-term patient survival. Patients and methods: Over the past seven yr, we performed 39 intestinal (ITx) and multivisceral (MTVx) transplants in 38 adult patients. In the early period, daclizumab was used for induction, and tacrolimus and steroids were administered for maintenance [daclizumab and tacrolimus (DT) group; n = 11]. From 2002, we used alemtuzumab for induction, with low-dose tacrolimus maintenance [alemtuzumab and tacrolimus (AT) group; n = 23]. The incidence of bacterial infections and patient outcome were compared between the two groups. Results: There were no significant differences in recipient and donor demographics, procedure (ITx vs. MTVx), and cold and warm ischemic time between the two groups. Within 30d after ITx, bacterial infections were observed in seven patients (64%) in the DT and in 14 patients (64%) in the AT group. Between 30 and 180d after ITx, a total of 17 episodes of bacterial infections were observed in the DT and 26 episodes in the AT group. Three patients in the DT and eight in the AT group died, and all of the deaths were related to infectious complications except one each in DT and AT. Conclusion: There was no difference in incidence of bacterial infections and long-term patient survival between the two groups.

Original languageEnglish
Pages (from-to)420-425
Number of pages6
JournalClinical Transplantation
Volume23
Issue number3
DOIs
Publication statusPublished - 2009

Keywords

  • Alemtuzumab
  • Bacterial infection
  • Induction therapy
  • Intestinal transplantation
  • Small bowel transplantation

ASJC Scopus subject areas

  • Transplantation

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    Kimura, T., Lauro, A., Cescon, M., Zanfi, C., Dazzi, A., Ercolani, G., Grazi, G. L., Vivarelli, M., Ravaioli, M., Del Gaudio, M., Cucchetti, A., Zanello, M., Labarba, G., Pironi, L., Lazzarotto, T., & Pinna, A. D. (2009). Impact of induction therapy on bacterial infections and long-term outcome in adult intestinal and multivisceral transplantation: A comparison of two different induction protocols: Daclizumab vs. alemtuzumab. Clinical Transplantation, 23(3), 420-425. https://doi.org/10.1111/j.1399-0012.2008.00922.x