Purpose: The purpose of this study was to compare outcomes (acute cellular rejection, graft loss, mortality) in intestinal transplant recipients who were converted from the standard protocol immunosuppression regimen (tacrolimus and corticosteroids) to an alternative regimen.

Methods: This study was a retrospective chart review including intestinal transplant recipients transplanted between January 2004 and December 2006. Patients were included if they received an isolated intestinal transplant or a multivisceral transplant and were on initiated on the maintenance immunosuppression regimen of tacrolimus and corticosteroids. The primary outcome was the incidence of acute cellular rejection. Secondary outcomes included incidence of intestinal graft loss and incidence of mortality.

Results: There were 69 intestinal transplant recipients between January 2004 and December 2006 that were included in the analysis. All recipients had an initial maintenance immunosuppression regimen consisting of tacrolimus and corticosteroids. Forty six (67%) patients remained on their initial immunosuppression regimen. Eighteen (39%) of these patients developed acute cellular rejection. Twenty three (33%) patients were converted to alternative regimens consisting of combinations of tacrolimus, cyclosporine, corticosteroids, mycophenolate, azathioprine, and sirolimus. Ten (43%) of these patients developed an acute cellular rejection. Eight (17%) patients that remained on their initial immunosuppression regimen experienced graft loss and 20 (43%) patients in this group died. Four (17%) patients that were converted to an alternative regimen experienced graft loss and 14 (61%) patients in this group died.

Conclusion: Patients who require immunosuppression regimen changes due to intolerance of tacrolimus and corticosteroids may have similar clinical outcomes in terms of acute cellular rejection and graft loss but a trend towards an increased incidence of mortality.

CITATION INFORMATION: Patel R, Keck M, Collier D, Vacha M. Appraisal of Alternative Immunosuppression Regimens in Intestinal Transplant Recipients: A Single Center Experience. Am J Transplant. 2016;16 (suppl 3).

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