The First Collective Examination of Immunosuppressive Practices Among American Intestinal Transplant Centers.
Journal
Transplantation direct
ISSN: 2373-8731
Titre abrégé: Transplant Direct
Pays: United States
ID NLM: 101651609
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
15
05
2023
accepted:
23
05
2023
medline:
28
8
2023
pubmed:
28
8
2023
entrez:
28
8
2023
Statut:
epublish
Résumé
Unlike other solid organs, no standardized treatment algorithms exist for intestinal transplantation (ITx). We established a consortium of American ITx centers to evaluate current practices. All American centers performing ITx during the past 3 y were invited to participate. As a consortium, we generated questions to evaluate and collect data from each institution. The data were compiled and analyzed. Ten centers participated, performing 211 ITx during the past 3 y (range, 3-46; mean 21.1). Induction regimens varied widely. Thymoglobulin was the most common, used in the plurality of patients (85/211; 40.3%), but there was no consensus regimen. Similarly, regimens for the treatment of acute cellular rejection, antibody-mediated rejection, and graft-versus-host disease varied significantly between centers. We also evaluated differences in maintenance immunosuppression protocols, desensitization regimens, mammalian target of rapamycin use, antimetabolite use, and posttransplantation surveillance practices. Maintenance tacrolimus levels, stoma presence, and scoping frequency were not associated with differences in rejection events. Definitive association between treatments and outcomes, including graft and patient survival, was not the intention of this initial collaboration and is prevented by the lack of patient-level data and the presence of confounders. However, we identified trends regarding rejection episodes after various induction strategies that require further investigation in our subsequent collaborations. This initial collaboration reveals the extreme heterogeneity of practices among American ITx centers. Future collaboration will explore patient-level data, stratified by age and transplant type (isolated intestine versus multivisceral), to explore the association between treatment regimens and outcomes.
Sections du résumé
Background
UNASSIGNED
Unlike other solid organs, no standardized treatment algorithms exist for intestinal transplantation (ITx). We established a consortium of American ITx centers to evaluate current practices.
Methods
UNASSIGNED
All American centers performing ITx during the past 3 y were invited to participate. As a consortium, we generated questions to evaluate and collect data from each institution. The data were compiled and analyzed.
Results
UNASSIGNED
Ten centers participated, performing 211 ITx during the past 3 y (range, 3-46; mean 21.1). Induction regimens varied widely. Thymoglobulin was the most common, used in the plurality of patients (85/211; 40.3%), but there was no consensus regimen. Similarly, regimens for the treatment of acute cellular rejection, antibody-mediated rejection, and graft-versus-host disease varied significantly between centers. We also evaluated differences in maintenance immunosuppression protocols, desensitization regimens, mammalian target of rapamycin use, antimetabolite use, and posttransplantation surveillance practices. Maintenance tacrolimus levels, stoma presence, and scoping frequency were not associated with differences in rejection events. Definitive association between treatments and outcomes, including graft and patient survival, was not the intention of this initial collaboration and is prevented by the lack of patient-level data and the presence of confounders. However, we identified trends regarding rejection episodes after various induction strategies that require further investigation in our subsequent collaborations.
Conclusions
UNASSIGNED
This initial collaboration reveals the extreme heterogeneity of practices among American ITx centers. Future collaboration will explore patient-level data, stratified by age and transplant type (isolated intestine versus multivisceral), to explore the association between treatment regimens and outcomes.
Identifiants
pubmed: 37636483
doi: 10.1097/TXD.0000000000001512
pmc: PMC10455426
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e1512Subventions
Organisme : NIAID NIH HHS
ID : K23 AI156026
Pays : United States
Informations de copyright
Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Am J Surg Pathol. 2008 Sep;32(9):1367-72
pubmed: 18763324
Transplantation. 2010 Dec 27;90(12):1574-80
pubmed: 21107306
Am J Transplant. 2021 Feb;21 Suppl 2:316-355
pubmed: 33595193
Am J Transplant. 2005 Jun;5(6):1430-6
pubmed: 15888051
Am J Transplant. 2016 Oct;16(10):2973-2985
pubmed: 27037650
Transplantation. 2020 Oct;104(10):2179-2188
pubmed: 31929428
Transplantation. 2014 Jan 15;97(1):78-82
pubmed: 24092376
Hum Pathol. 2016 Oct;56:89-92
pubmed: 27246175
Am J Transplant. 2022 Nov;22(11):2608-2615
pubmed: 35833730
J Pediatr Gastroenterol Nutr. 2021 Mar 1;72(3):417-424
pubmed: 33560758
Clin Transpl. 2014;:49-54
pubmed: 26281126
Am J Transplant. 2019 Jul;19(7):2077-2091
pubmed: 30672105
J Pediatr Surg. 2014 Jan;49(1):13-8
pubmed: 24439573
Curr Opin Organ Transplant. 2022 Apr 1;27(2):119-125
pubmed: 35232925
Am J Transplant. 2020 Jan;20 Suppl s1:300-339
pubmed: 31898410
Am J Transplant. 2021 May;21(5):1705-1712
pubmed: 33043624
N Engl J Med. 2009 Sep 3;361(10):998-1008
pubmed: 19726774