Daclizumab and Alemtuzumab as induction agents in adult intestinal and multivisoeral transplantation: rejections and infections on 40 recipients during the early post-operative period.

摘要

Introduction: Allograft rejection in intestinal transplantation is frequent and bacterial, fungal and viral infections related to elevate immunosuppression regimen remain an important post-transplant drawback. Induction therapy has been adopted and allowed improvements in graft and patients survival. Patients and Methods: Between December 2000 and August 2009 we performed 43 intestinal transplants in 42 adult recipients (median age 34.8 +- 9.5 years, M/F: 22/20, isolated/multivisceral graft: 32/11).We compared, during first 30 days post-transplantation, 40 recipients, allocated in two groups, treated with Daclizumab (Zenapax~R - 12 patients: 8 isolated intestinal graft and 4 multivisceral) or Alemtuzumab (Campath-1H~R - 28 patients: 22 isolated intestinal graft and 6 multivisceral). Maintenance immunosuppression was based on Tacrolimus and steroids in the first group and low doses of Tacrolimus in the second one. Results: During first month, 8 Daclizumab recipients (66.6 %) experienced 9 ACRs of mild degree, successfully treated with steroids; 8 patients (66.6%) developed a bacterial infection requiring treatment. We found 14 ACRs in 12 Alemtuzumab recipients (42.8 %), 5 mild degree, 1 moderate and 1 mild-moderate; 16 patients (57.1 %) required treatment for infections. 5-years patient cumulative survival is 66 % for daclizumab recipients and 43 % for alemtuzumab patients; 5-years graft survivals is 66 % for daclizumab recipient and 41 % for alemtuzumab group. In both cases p value is not statistically significative. Discussion and Conclusions: Infection rate is considerably high in both protocols. Alemtuzumab seems to offer a better immunosuppression against ACRs during first month.