The challenge of electing and maintaining immunosuppressive protocols after intestinal transplant. Impact on freedom from rejection survival and graft loss

M, GENTILINI; H, SOLAR; J, TRENTADUE; G, GONDOLESI; L, PEREZ ILLIDGE; M, FERNANDEZ; A, CABANNE; C, RUMBO; D, RAMISCH; M, RUMBO

Congreso; CIRTA 2021; 2021

POSTER PRESENTATIONSP-08: The Challenge of Electing and Maintaining Immunosuppressive Protocols after Intestinal Transplant. Impact on Freedom from Rejection Survival and Graft LossM, Gentilini1; L, Perez Illidge1; C, Rumbo2; H, Solar2; M, Fernandez2; D, Ramish2; J, Trentadue4; A, Cabanne3; M, Rumbo5; G, Gondolesi2Author InformationTransplantation: July 2021 - Volume 105 - Issue 7S - p S51doi: 10.1097/01.tp.0000757836.65061.73FREE MetricsImmunosuppressive protocols (IP) have changed over the last decade; however, there is a lack of reports on long-term maintenance and variations along the follow-up. We aim to report the long-term incidence of acute cellular rejection (ACR) with a prospectively defined induction protocol based on recipient´s pre-transplant immunological risk (Low Risk (LR) and High Risk (HR)), and variations made over the post-transplant course by group.Methods: LR group included isolated Intestinal Transplant (ITx), ABO compatible match, or PRA 30%, requiring a desensitization protocol, or B cell positive Cross Match. Induction therapy in LR was IL-2 Ab and steroids, TAC and MMF; HR received thymoglobulin with steroids, TAC and Sirolimus. A retrospective analysis of a prospective database was conducted.Results: A total of 51 ITx were performed from May/2006 to December/2020. Six patients were excluded (dead or graft loss during week 1 post-ITx). Twenty-four patients were LR, and 21 HR. A total of 87 episodes of ACR occurred in 45 patients (45 mild, 18 moderate and 24 severe, p=NS). Mean time from ITx to 1st ACR was 218±671 days in LR and 66±150 days in HR (p=NS). The analysis of individual changes based on clinical course, showed that 33% of LR patients remained in the primary selected IP, 33% were left on double therapy (TAC-Steroid) and 42% were switched to Sirolimus. Only 38% of the HR patients remained in the primary selected group, 19% were left on double therapy and 19% switched to MMF due to renal insufficiency (p=NS). Patients and 5-year graft survival were 54% and 6% for LR vs. 65% and 0% for HR (p=NS). Rejection-related graft loss by group: 8 in LR and 7 in HR (p=NS). Rejection-related graft loss occurred after the 3rd post-ITx month in LR, 2 during the first trimester (p