Improved outcome after intestinal transplantation at a single institution over 12 years

“…Both clinical and experimental data have demonstrated that intestinal allografts elicit a strong immune response (24). The severity of this immune response contributes to the lowered graft and patient survival rates in patients undergoing SBTx, especially when compared with other organs such as the heart or kidney (23)(24)(25)(26). However, because HLA compatibility is not a criterion for intestinal transplantation, a small bowel allograft appears to be fundamentally different from other organs.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of C4d Deposition and Circulating Antibody in Small Bowel Transplantation

Serre

Canioni

Lacaille

et al. 2008

American Journal of Transplantation

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Antibody-mediated rejection (AMR) consensus criteria are defined in kidney and heart transplantation by histological changes, circulating donor-specific antibody (DSA), and C4d deposition in affected tissue. AMR consensus criteria are not yet identified in small bowel transplantation (SBTx). We investigated those three criteria in 12 children undergoing SBTx, including one retransplantation and four combined liver-SBTx (SBTx), with a follow-up of 12 days to 2 years. All biopsies (91) were evaluated with a standardized grading scheme for acute rejection (AR), vascular lesions and C4d expression. Sera were obtained at day 0 and during the follow-up. C4d was expressed in 37% of biopsies with or without AR, but in 50% of biopsies with severe vascular lesions. In addition, vascular lesions were always associated with AR and a poor outcome. All children with AR (grade 2 or 3) observed before the third month died or lost the graft. DSA were never found in any studied sera. We found no evidence that C4d deposition was of any clinical relevance to the outcome of SBTx. However, the grading of vascular lesions may constitute a useful marker to identify AR that is potentially resistant to standard treatment, and for which an alternative therapy should be considered.

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“…Compliance was assessed over the past 4 weeks. Noncompliance was defined as any self-reported noncompliance (response score 1 to 5) on any of the 4 items to compensate for the underreporting of noncompliance using self-report 16 and the limited forgiveness of noncompliance with immunosuppressive drugs in view of negative clinical outcomes. 17 HRQoL was assessed at time points t0, t2 and t3 using the EORTC QLQ-C30 questionnaire.…”

Section: Methodsmentioning

confidence: 99%

Cognitive Evaluation in Liver Transplant Patients Under Calcineurin Inhibitor Maintenance Therapy

Heits

Keserovic

Mund

et al. 2017

Transplantation Direct

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BackgroundNeurological disorders due to calcineurin inhibitor (CNI) treatment pose a well-known problem after liver transplantation (LTx). In this study, the impact of CNIs on cognitive functioning during maintenance therapy was analyzed. A possible improvement of cognitive functioning, compliance and health-related quality of life (HRQoL) after conversion to a once-daily tacrolimus formulation was prospectively assessed.MethodsIn a cross-section analysis cognitive functioning of living donors (LD), waiting list patients and LTx patients was tested using a 4 times trail making test (4-TTMT). In a further investigator-initiated trial a possible improvement of cognitive functioning, HRQoL and compliance after conversion to the once-daily tacrolimus formulation was prospectively assessed over 1 year. HRQoL was assessed using an EORTC-QLQ C30 questionnaire and patient’s compliance was assessed by the Basel Assessment of Compliance with Immunosuppressive Medication Scales questionnaire. Correlated data were sex, age, time after surgery, liver disease, model of end-stage liver disease score, creatinine, CNI type, and CNI trough levels.ResultsTwo hundred eleven patients were included in this cross-section analysis. Twenty-seven patients agreed to participate in the investigator-initiated trial. LTx patients completed the 4-TTMT slower than living donor patients and faster than waiting list patients. Patients with twice daily cyclosporine A (CSA) formulation needed longer to finish the 4-TTMT than patients with the once-daily tacrolimus formulation. After drug conversion of a twice-daily CNI formulation to a once-daily tacrolimus formulation, CSA-treated patients needed longer to improve their cognitive functioning. HRQoL and compliance did not improve after drug conversion.ConclusionsPatients with once-daily tacrolimus formulation had a better psychomotor speed than CSA-treated patients. The conversion to once-daily tacrolimus formulation significantly improved cognitive functioning, but had no impact on HRQoL or compliance.

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Improved outcome after intestinal transplantation at a single institution over 12 years

Cited by 15 publications

References 7 publications

Induction Immunosuppression With Thymoglobulin and Rituximab in Intestinal and Multivisceral Transplantation

Induction Immunosuppression With Thymoglobulin and Rituximab in Intestinal and Multivisceral Transplantation

Evaluation of C4d Deposition and Circulating Antibody in Small Bowel Transplantation

Cognitive Evaluation in Liver Transplant Patients Under Calcineurin Inhibitor Maintenance Therapy

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