Trends in the Perioperative Practices for Immunological Assessment and Immunosuppression Strategies for Patients Undergoing Intestinal Transplantation at American Transplant Centers
Recommended Citation
Abusuliman M, Jafri SM, Summers BB, Beduschi T, Boike J, Farmer DG, Horslen S, Lyer K, Langnas AN, Mangus RS, Matsumoto CS, Mavis AM, Mazariegos GV, Nagai S, O'Leary J, Schiano TD, Sudan DL, Abusuliman A, Sulejmani N, and Segovia MC. Trends in the Perioperative Practices for Immunological Assessment and Immunosuppression Strategies for Patients Undergoing Intestinal Transplantation at American Transplant Centers. Transplant Proc 2025.
Document Type
Article
Publication Date
1-30-2025
Publication Title
Transplantation proceedings
Abstract
BACKGROUND: Intestinal transplantation (IT) is a complex procedure that requires nuanced immunosuppressive strategies to optimize patient outcomes. Despite advancements, significant variability remains in immunosuppressive protocols across transplant centers due to a lack of consensus on the optimal approaches for induction, maintenance, and clinical testing. This variability complicates standardization and identification of best practices for IT recipients.
METHODS: A descriptive survey study was conducted to characterize immunosuppressive and testing strategies in IT at major transplant centers in the United States. Ten centers known to have performed over 10 ITs since 2015 were selected from the Scientific Registry of Transplant Recipients database. A 22-question survey was distributed to surgical directors, collecting data on pre-, peri-, and post-transplant immunological testing, desensitization strategies, immunosuppressive regimens, and management of antibody-mediated rejection (AMR) and acute cellular rejection (ACR).
RESULTS: Nine centers (90%) responded. All centers conducted pretransplant human leukocyte antigen (HLA) and donor-specific antibody (DSA) testing, with varying frequencies and methodologies. Desensitization was reported by 44% of centers for isolated IT and by 22% for multivisceral transplants. Induction therapy predominantly involved antithymocyte globulin (89%) and rituximab (44%). Tacrolimus was universally used for maintenance, with varying trough level targets across centers. Post-transplant DSA testing was performed by all centers, and protocol-driven endoscopic bowel biopsies were routine at 67% of centers. AMR was diagnosed at 89% of centers, with plasmapheresis and IVIG being the most common treatments. Variability was noted in desensitization practices and AMR management.
CONCLUSION: This survey highlights considerable consistency in pre- and post-transplant testing and immunosuppressive regimens for IT recipients, while significant variability exists in desensitization strategies and AMR management. Further research is needed to standardize these practices to improve patient outcomes across transplant centers.
PubMed ID
39890513
ePublication
ePub ahead of print
