Induction immunosuppression with thymoglobulin and rituximab in intestinal and multivisceral transplantation

Rodrigo Vianna, Richard S. Mangus, Jonathan A. Fridell, Sheila Weigman, Marwan Kazimi, Joseph Tector

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

BACKGROUND. Induction immunosuppression is now a common practice after intestinal and multivisceral transplantation. We report our experience in 27 adult recipients who received rituximab and rabbit antithymocyte globulin (rATG) in combination as induction agents. MATERIAL AND METHODS. Twenty-seven adult patients received 29 intestinal transplants between July 2004 and March 2007. All patients received induction immunosuppression therapy with rATG, rituximab, and steroids. Tacrolimums and a steroid taper were used for maintenance therapy. Patient and graft survival, episodes of rejection as well as posttransplant lymphoproliferative disease (PTLD) and graft-versus-host disease were analyzed. RESULTS. One-year patient and graft survival was 81% and 76%, respectively. Thirteen patients (48%) experienced 19 episodes of acute rejection (9 mild episodes, 2 moderate, and 8 severe). Patients with a multivisceral graft experienced less episodes of severe acute rejection (1 of 19, 5%) when compared with isolated intestinal transplants and modified multivisceral transplants (7 of 10, 70%). Two patients had episodes of skin graft-versus-host disease that responded to steroid boluses. PTLD was not seen in our series. Two patients developed cytomegalovirus enteritis. CONCLUSIONS. The combination of rATG and rituximab was an effective induction therapy in our preliminary data. The number and severity of rejection episodes increased when the liver was not included as part of the graft. An immunosuppression regimen including rATG, rituximab, and steroids may have a protective effect against PTLD and chronic rejection.

Original languageEnglish (US)
Pages (from-to)1290-1293
Number of pages4
JournalTransplantation
Volume85
Issue number9
DOIs
StatePublished - May 2008
Externally publishedYes

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Immunosuppression
Transplantation
Antilymphocyte Serum
Transplants
Steroids
Rabbits
Graft vs Host Disease
Graft Survival
Enteritis
Rituximab
thymoglobulin
Cytomegalovirus
Chronic Disease
Therapeutics
Skin
Liver

Keywords

  • Intestinal transplantation
  • Rabbit antithymocyte globulin
  • rATG
  • Rejection
  • Rituximab
  • Thymoglobulin
  • Transplant outcomes

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Induction immunosuppression with thymoglobulin and rituximab in intestinal and multivisceral transplantation. / Vianna, Rodrigo; Mangus, Richard S.; Fridell, Jonathan A.; Weigman, Sheila; Kazimi, Marwan; Tector, Joseph.

In: Transplantation, Vol. 85, No. 9, 05.2008, p. 1290-1293.

Research output: Contribution to journalArticle

Vianna, Rodrigo ; Mangus, Richard S. ; Fridell, Jonathan A. ; Weigman, Sheila ; Kazimi, Marwan ; Tector, Joseph. / Induction immunosuppression with thymoglobulin and rituximab in intestinal and multivisceral transplantation. In: Transplantation. 2008 ; Vol. 85, No. 9. pp. 1290-1293.
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abstract = "BACKGROUND. Induction immunosuppression is now a common practice after intestinal and multivisceral transplantation. We report our experience in 27 adult recipients who received rituximab and rabbit antithymocyte globulin (rATG) in combination as induction agents. MATERIAL AND METHODS. Twenty-seven adult patients received 29 intestinal transplants between July 2004 and March 2007. All patients received induction immunosuppression therapy with rATG, rituximab, and steroids. Tacrolimums and a steroid taper were used for maintenance therapy. Patient and graft survival, episodes of rejection as well as posttransplant lymphoproliferative disease (PTLD) and graft-versus-host disease were analyzed. RESULTS. One-year patient and graft survival was 81{\%} and 76{\%}, respectively. Thirteen patients (48{\%}) experienced 19 episodes of acute rejection (9 mild episodes, 2 moderate, and 8 severe). Patients with a multivisceral graft experienced less episodes of severe acute rejection (1 of 19, 5{\%}) when compared with isolated intestinal transplants and modified multivisceral transplants (7 of 10, 70{\%}). Two patients had episodes of skin graft-versus-host disease that responded to steroid boluses. PTLD was not seen in our series. Two patients developed cytomegalovirus enteritis. CONCLUSIONS. The combination of rATG and rituximab was an effective induction therapy in our preliminary data. The number and severity of rejection episodes increased when the liver was not included as part of the graft. An immunosuppression regimen including rATG, rituximab, and steroids may have a protective effect against PTLD and chronic rejection.",
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AU - Kazimi, Marwan

AU - Tector, Joseph

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N2 - BACKGROUND. Induction immunosuppression is now a common practice after intestinal and multivisceral transplantation. We report our experience in 27 adult recipients who received rituximab and rabbit antithymocyte globulin (rATG) in combination as induction agents. MATERIAL AND METHODS. Twenty-seven adult patients received 29 intestinal transplants between July 2004 and March 2007. All patients received induction immunosuppression therapy with rATG, rituximab, and steroids. Tacrolimums and a steroid taper were used for maintenance therapy. Patient and graft survival, episodes of rejection as well as posttransplant lymphoproliferative disease (PTLD) and graft-versus-host disease were analyzed. RESULTS. One-year patient and graft survival was 81% and 76%, respectively. Thirteen patients (48%) experienced 19 episodes of acute rejection (9 mild episodes, 2 moderate, and 8 severe). Patients with a multivisceral graft experienced less episodes of severe acute rejection (1 of 19, 5%) when compared with isolated intestinal transplants and modified multivisceral transplants (7 of 10, 70%). Two patients had episodes of skin graft-versus-host disease that responded to steroid boluses. PTLD was not seen in our series. Two patients developed cytomegalovirus enteritis. CONCLUSIONS. The combination of rATG and rituximab was an effective induction therapy in our preliminary data. The number and severity of rejection episodes increased when the liver was not included as part of the graft. An immunosuppression regimen including rATG, rituximab, and steroids may have a protective effect against PTLD and chronic rejection.

AB - BACKGROUND. Induction immunosuppression is now a common practice after intestinal and multivisceral transplantation. We report our experience in 27 adult recipients who received rituximab and rabbit antithymocyte globulin (rATG) in combination as induction agents. MATERIAL AND METHODS. Twenty-seven adult patients received 29 intestinal transplants between July 2004 and March 2007. All patients received induction immunosuppression therapy with rATG, rituximab, and steroids. Tacrolimums and a steroid taper were used for maintenance therapy. Patient and graft survival, episodes of rejection as well as posttransplant lymphoproliferative disease (PTLD) and graft-versus-host disease were analyzed. RESULTS. One-year patient and graft survival was 81% and 76%, respectively. Thirteen patients (48%) experienced 19 episodes of acute rejection (9 mild episodes, 2 moderate, and 8 severe). Patients with a multivisceral graft experienced less episodes of severe acute rejection (1 of 19, 5%) when compared with isolated intestinal transplants and modified multivisceral transplants (7 of 10, 70%). Two patients had episodes of skin graft-versus-host disease that responded to steroid boluses. PTLD was not seen in our series. Two patients developed cytomegalovirus enteritis. CONCLUSIONS. The combination of rATG and rituximab was an effective induction therapy in our preliminary data. The number and severity of rejection episodes increased when the liver was not included as part of the graft. An immunosuppression regimen including rATG, rituximab, and steroids may have a protective effect against PTLD and chronic rejection.

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KW - Rabbit antithymocyte globulin

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