The First Collective Examination of Immunosuppressive Practices Among American Intestine Transplant Centers
Llore N, Fujiki M, Segovia M, Jafri SM, Obri M, Liggett J, Kroemer A, Matsumoto C, Moon J, DiCocco P, Selvaggi G, Garcia J, Ganoza A, Khanna A, Mazariegos G, Wendel D, Reyes J, Ormsby D, and Weiner J. The First Collective Examination of Immunosuppressive Practices Among American Intestine Transplant Centers. Transplantation 2023; 107(7S):15-15.
Purpose: No standardized treatment algorithms exist for intestine transplantation (ITx), unlike other solid organs. We established a consortium of American ITx centers to evaluate our widely varying practices, with the goal of establishing best practices.
Methods: All American centers performing ITx during the past 3 years were invited to participate. As a consortium, we generated questions to evaluate and collected data from each institution. The data were compiled and analyzed.
Results: Ultimately 10/15 centers participated, performing 211 intestine transplants over the past three years (range 3-46, mean 21.1). Induction regimens varied widely, even within individual centers. Thymoglobulin was the most common, used by 6 centers exclusively, as one of several options at the remaining 4 centers, and in the plurality of patients (85/211, 40.3%), but there was no consensus regimen (Figure 1). Similarly, first- and second-line regimens for treatment of acute cellular and antibody-mediated rejection varied widely between centers (data not shown). Thymoglobulin induction was associated with the highest rate of rejection events when used as monotherapy (47%) but also the lowest rate when rituximab was added (23%) (Figure 2A). On the other hand, rejection events associated with thymoglobulin monotherapy and alemtuzumab were mostly mild, while those associated with thymoglobulin/rituximab and basiliximab were mostly moderate or severe (Figure 2B). No regimen was associated with increased rates of GVHD or PTLD. Maintenance tacrolimus levels, presence of stoma, and frequency of scoping were not associated with differences in rejection events.
Conclusion: This collaboration reveals the extreme heterogeneity of practices among American ITx centers and the association of certain induction regimens with rejection. Future collaboration will explore survival data and outcomes related to treatment regimens for rejection, GVHD, and PTLD.