New Anti-Rejection Protocol Improves Survival

Researchers have developed a new anti-rejection protocol that reduces rejection and infection rates of intestinal transplants, raising survival to 96% after the first year.

The new protocol uses a novel immunosuppression-minimization protocol, avoiding the use of several anti-rejection drugs that can cause serious infections and major complications. The protocol involves giving a one-time pre-transplant dose of either the drug thymoglobulin, which kills and depletes T cells, or a similar drug called campath, which depletes both T and B cells, immune system cells involved in organ rejection.

Following intestinal transplantation in July 2001, 103 patients who received thymoglobulin and the 20 patients who received campath also received the standard anti-rejection drug tacrolimus, but none of the patients received steroids. Tapering of tacrolimus was attempted after 120 days. While 43% of patients had some level of rejection before the initial weaning, none showed evidence of chronic rejection. Patients under the campath protocol did slightly better than those treated with thymoglobulin. Of the 123 transplants, 55 involved children. Today, 109 recipients are alive, with 107 having functioning grafts.

"The fact that we have been able to significantly reduce the amount of anti-rejection drugs in this group of patients has enabled many of them to live full and productive lives,” remarked lead author Kareem Abu-Elmagd, M.D., Ph.D., professor of surgery at the University of Pittsburgh School of Medicine and director of the Intestinal Rehabilitation and Transplant Center at the Medical Center's Thomas E. Starzl Transplantation Institute (PA, USA). The results were presented at the 3rd International Conference on Immunosuppression in San Diego (CA, USA) in December 2004.