Trends in the Perioperative Practices for Immunological Assessment and Immunosuppression Strategies for Patients Undergoing Intestinal Transplantation at American Transplant Centers

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-30 DOI:10.1016/j.transproceed.2025.01.002

Mohammed Abusuliman , Syed-Mohammed Jafri , Bryant B. Summers , Thiago Beduschi , Justin Boike , Douglas G. Farmer , Simon Horslen , Kishore Lyer , Alan N. Langnas , Richard S. Mangus , Cal S. Matsumoto , Alisha M. Mavis , George V. Mazariegos , Shunji Nagai , Jacqueline O'Leary , Thomas D. Schiano , Debra L. Sudan , Amr Abusuliman , Nimisha Sulejmani , Maria Cristina Segovia

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引用次数: 0

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

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美国移植中心肠移植患者围手术期免疫评估和免疫抑制策略的趋势

背景：肠移植（IT）是一个复杂的过程，需要细致的免疫抑制策略来优化患者的预后。尽管取得了进展，但由于在诱导、维持和临床试验的最佳方法上缺乏共识，各移植中心的免疫抑制方案仍然存在显著差异。这种可变性使IT接收者最佳实践的标准化和识别变得复杂。方法：在美国主要移植中心进行了一项描述性调查研究，以表征IT的免疫抑制和测试策略。从移植受者科学登记数据库中选择了自2015年以来已知进行了10次以上ITs的10个中心。向外科主任分发了一份22个问题的调查，收集了移植前、移植期和移植后的免疫检测、脱敏策略、免疫抑制方案以及抗体介导的排斥反应（AMR）和急性细胞排斥反应（ACR）的管理数据。结果：9个中心（90%）有反应。所有中心都进行移植前人类白细胞抗原（HLA）和供体特异性抗体（DSA）检测，检测频率和方法各不相同。44%的孤立性IT中心报告脱敏，22%的多脏器移植中心报告脱敏。诱导治疗主要包括抗胸腺细胞球蛋白（89%）和利妥昔单抗（44%）。他克莫司普遍用于维持，不同中心的低谷水平目标不同。所有中心都进行移植后DSA检查，67%的中心常规进行内镜下肠活检。89%的中心诊断出AMR，血浆置换和IVIG是最常见的治疗方法。在脱敏实践和抗菌素耐药性管理中注意到可变性。结论：这项调查强调了移植前和移植后检测和免疫抑制方案的一致性，而脱敏策略和AMR管理存在显著差异。需要进一步的研究来规范这些做法，以改善移植中心的患者预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.