Login Register Cart 0
Generic placeholder image

Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Immunosuppression in Visceral Transplantation: Current Trends and Future Perspectives

Author(s): Ariane Backes, Rodrigo Vianna and Thiago Beduschi*

Volume 26, Issue 28, 2020

Page: [3418 - 3424] Pages: 7

DOI: 10.2174/1381612826666200707131857

Price: $65

Abstract

Visceral transplant represents an immunologic challenge due to high intestinal graft immunogenicity. Over the last 20 years, significant advances in immunosuppression regimens have resulted in excellent short-term outcomes.

Currently, visceral transplant is the standard of care for patients with gut failure having life-threatening complications and complex abdominal pathology. In this review, we describe immunosuppressive strategies in the visceral transplant field.

Keywords: Intestinal transplant, visceral transplant, multi-visceral transplant, immunosuppression, future perspectives, current trends.

« Previous Next »
[1]
Abu-Elmagd KM, Costa G, Bond GJ, et al. Evolution of the immunosuppressive strategies for the intestinal and multivisceral recipients with special reference to allograft immunity and achievement of partial tolerance. Transpl Int 2009; 22(1): 96-109.
[http://dx.doi.org/10.1111/j.1432-2277.2008.00785.x] [PMID: 18954362]
[2]
Grant D, Abu-Elmagd K, Mazariegos G, et al. Intestinal Transplant Association. Intestinal transplant registry report: global activity and trends. Am J Transplant 2015; 15(1): 210-9.
[http://dx.doi.org/10.1111/ajt.12979] [PMID: 25438622]
[3]
Parekh N, Elmagd A. Visceral transplantation: Current trends and long-term outcomes Contemporany pancreas and small bowel transplantation Organ and tissue transplantation. Springer Nature Switzerland AG 2019; pp. 273-90.
[http://dx.doi.org/10.1007/978-3-319-05257-1_25]
[4]
Starzl TE, Todo S, Fung J, Demetris AJ, Venkataramman R, Jain A. FK 506 for liver, kidney, and pancreas transplantation. Lancet 1989; 2(8670): 1000-4.
[http://dx.doi.org/10.1016/S0140-6736(89)91014-3] [PMID: 2478846]
[5]
Grant W. Surgical complications of intestinal transplantation Intestinal failure: diagnosis, management and transplantation. London: Blackwell 2008.
[http://dx.doi.org/10.1002/9781405195805.ch33]
[6]
Vianna R, Beduschi T. Intestine retransplantation in the intestine or liver-intestine recipient Solid organ transplantation in infants and children organ and tissue transplantation. Springer International Publishing AG 2017; pp. 1-10.
[http://dx.doi.org/10.1007/978-3-319-08049-9_26-1]
[7]
Vianna RM, Mangus RS, Fridell JA, Weigman S, Kazimi M, Tector J. Induction immunosuppression with thymoglobulin and rituximab in intestinal and multivisceral transplantation. Transplantation 2008; 85(9): 1290-3.
[http://dx.doi.org/10.1097/TP.0b013e31816dd450] [PMID: 18475186]
[8]
Reyes J, Mazariegos GV, Abu-Elmagd K, et al. Intestinal transplantation under tacrolimus monotherapy after perioperative lymphoid depletion with rabbit anti-thymocyte globulin (thymoglobulin). Am J Transplant 2005; 5(6): 1430-6.
[http://dx.doi.org/10.1111/j.1600-6143.2005.00874.x] [PMID: 15888051]
[9]
Nishida S, Levi DM, Moon JI, et al. Intestinal transplantation with alemtuzumab (Campath-1H) induction for adult patients. Transplant Proc 2006; 38(6): 1747-9.
[http://dx.doi.org/10.1016/j.transproceed.2006.05.057] [PMID: 16908270]
[10]
Fishbein TM. Current concepts intestinal transplantation. N Engl Med 2009; 361: 998-1008.
[http://dx.doi.org/10.1056/NEJMra0804605]
[11]
Anderson E. Pharmacologic considerations in multivisceral transplantation Contemporany pancreas and small bowel transplantation Organ and tissue transplantation. Springer Nature Switzerland AG 2019; pp. 415-26.
[http://dx.doi.org/10.1007/978-3-319-05257-1_21]
[12]
Antanasov G, Pascher A. Induction and maintenance immunosuppression in intestinal transplantation Solid organ transplantation in infants and children Organ and tissue transplantation. Springer International Publishing AG 2017; pp. 1-13.
[13]
Pirenne J, Kawai M. Intestinal transplantation: evolution in immunosuppression protocols. Curr Opin Organ Transplant 2009; 14(3): 250-5.
[http://dx.doi.org/10.1097/MOT.0b013e32832b2eb7] [PMID: 19373085]
[14]
Gerlach UA, Atanasov G, Wallenta L, et al. Short-term TNF-alpha inhibition reduces short-term and long-term inflammatory changes post-ischemia/reperfusion in rat intestinal transplantation. Transplantation 2014; 97(7): 732-9.
[http://dx.doi.org/10.1097/TP.0000000000000032] [PMID: 24598936]
[15]
Pascher A, Klupp J. Biologics in the treatment of transplant rejection and ischemia/reperfusion injury: new applications for TNFalpha inhibitors? BioDrugs 2005; 19(4): 211-31.
[http://dx.doi.org/10.2165/00063030-200519040-00002] [PMID: 16128605]
[16]
Abu-Elmagd KM. Preservation of the native spleen, duodenum, and pancreas in patients with multivisceral transplantation: nomenclature, dispute of origin, and proof of premise. Transplantation 2007; 84(9): 1208-9.
[http://dx.doi.org/10.1097/01.tp.0000287242.61220.4a] [PMID: 17998879]
[17]
Costa G, Parekh N, Osman M, Armanyous S, Fujiki M, Abu-Elmagd K. Composite and multivisceral transplantation: nomenclature, surgical techniques, current practice, and long-term outcome. Gastroenterol Clin North Am 2018; 47(2): 393-415.
[http://dx.doi.org/10.1016/j.gtc.2018.01.013] [PMID: 29735032]
[18]
Abu-Elmagd K, Reyes J, Bond G, et al. Clinical intestinal transplantation: a decade of experience at a single center. Ann Surg 2001; 234(3): 404-16.
[http://dx.doi.org/10.1097/00000658-200109000-00014] [PMID: 11524593]
[19]
Cheng EY, Busuttil RW. Liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: out of the unknown. JAMA Surg 2015; 150(12): 1158-9.
[http://dx.doi.org/10.1001/jamasurg.2015.1875] [PMID: 26309117]
[20]
Wong TW, Gandhi MJ, Daly RC, et al. Liver allograft provides immunoprotection for the cardiac allograft in combined heart-liver transplantation. Am J Transplant 2016; 16(12): 3522-31.
[http://dx.doi.org/10.1111/ajt.13870] [PMID: 27184686]
[21]
Olausson M, Mjörnstedt L, Nordén G, et al. Successful combined partial auxiliary liver and kidney transplantation in highly sensitized cross-match positive recipients. Am J Transplant 2007; 7(1): 130-6.
[http://dx.doi.org/10.1111/j.1600-6143.2006.01592.x] [PMID: 17227562]
[22]
Wu G, Cruz RJ Jr. Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection. Gastroenterol Rep (Oxf) 2018; 6(1): 29-37.
[http://dx.doi.org/10.1093/gastro/gox043] [PMID: 29479440]
[23]
Abu-Elmagd KM, Wu G, Costa G, et al. Preformed and de novo donor specific antibodies in visceral transplantation: long-term outcome with special reference to the liver. Am J Transplant 2012; 12(11): 3047-60.
[http://dx.doi.org/10.1111/j.1600-6143.2012.04237.x] [PMID: 22947059]
[24]
Hawksworth JS, Rosen-Bronson S, Island E, et al. Successful isolated intestinal transplantation in sensitized recipients with the use of virtual crossmatching. Am J Transplant 2012; 12(Suppl. 4): S33-42.
[http://dx.doi.org/10.1111/j.1600-6143.2012.04238.x] [PMID: 22947089]
[25]
Cheng EY, Kaneku H, Farmer DG. The Role of donor-specific antibodies in intestinal transplantation: experience at the university of California Los Angeles and literature review. Clin Transpl 2014; 153-9.
[PMID: 26281140]
[26]
Talayero P, Ramos Boluda E, Gómez Massa E, et al. Donor-specific antibodies in pediatric intestinal and multivisceral transplantation: the role of liver and human leukocyte antigen mismatching. Liver Transpl 2018; 24(12): 1726-35.
[http://dx.doi.org/10.1002/lt.25323] [PMID: 30112820]
[27]
Wu G, Cruz RJ. Liver inclusion improves outcomes of intestinal retransplantation in adults. Transplantation 2015; 99(6): 1265-72.
[http://dx.doi.org/10.1097/TP.0000000000000488] [PMID: 25427167]
[28]
Lauro A, Marino IR. Update on chronic rejection after intestinal transplant: an overview from experimental settings to clinical outcomes. Exp Clin Transplant 2019; 17(Suppl. 1): 18-30.
[http://dx.doi.org/10.6002/ect.MESOT2018.L32] [PMID: 30777519]
[29]
Newland MN, Nemeth TL. Induction and standard immunosuppresionSolid organ transplantation in infants and children Organ and tissue transplantation. Springer International Publishing AG 2017; pp. 1-29.
[30]
Grant D, Abu-Elmagd K, Reyes J, et al. Intestine Transplant Registry. 2003 report of the intestine transplant registry: a new era has dawned. Ann Surg 2005; 241(4): 607-13.
[http://dx.doi.org/10.1097/01.sla.0000157265.85388.a1] [PMID: 15798462]
[31]
Brayman k. New insights into the mechanisms of action of thymoglobulin. Transplantation 2007; 84: S3-4.
[http://dx.doi.org/10.1097/01.tp.0000295329.29278.8d]
[32]
Celik N, Stanley K, Rudolph J, et al. Improvements in intestine transplantation. Semin Pediatr Surg 2018; 27(4): 267-72.
[http://dx.doi.org/10.1053/j.sempedsurg.2018.07.001] [PMID: 30342602]
[33]
Trevizol AP, David AI, Dias ER, Mantovani D, Pécora R, D’Albuquerque LA. Intestinal and multivisceral transplantation immunosuppression protocols--literature review. Transplant Proc 2012; 44(8): 2445-8.
[http://dx.doi.org/10.1016/j.transproceed.2012.07.016] [PMID: 23026616]
[34]
Coelho T, Tredger M, Dhawan A. Current status of immunosuppressive agents for solid organ transplantation in children. Pediatr Transplant 2012; 16(2): 106-22.
[http://dx.doi.org/10.1111/j.1399-3046.2012.01644.x] [PMID: 22360399]
[35]
Lauro A, Zanfi C, Bagni A, et al. Induction therapy in adult intestinal transplantation: reduced incidence of rejection with “2-dose” alemtuzumab protocol. Clin Transplant 2013; 27(4): 567-70.
[http://dx.doi.org/10.1111/ctr.12166] [PMID: 23815302]
[36]
Ramirez CB, Marino IR. The role of basiliximab induction therapy in organ transplantation. Expert Opin Biol Ther 2007; 7(1): 137-48.
[http://dx.doi.org/10.1517/14712598.7.1.137] [PMID: 17150025]
[37]
Sarwal MM, Ettenger RB, Dharnidharka V, et al. Complete steroid avoidance is effective and safe in children with renal transplants: a multicenter randomized trial with three-year follow-up. Am J Transplant 2012; 12(10): 2719-29.
[http://dx.doi.org/10.1111/j.1600-6143.2012.04145.x] [PMID: 22694755]
[38]
Nishida S, Levi D, Kato T, et al. Ninety-five cases of intestinal transplantation at the University of Miami. J Gastrointest Surg 2002; 6(2): 233-9.
[http://dx.doi.org/10.1016/S1091-255X(01)00073-7] [PMID: 11992809]
[39]
Reyes J, Mazariegos GV, Bond GM, et al. Pediatric intestinal transplantation: historical notes, principles and controversies. Pediatr Transplant 2002; 6(3): 193-207.
[http://dx.doi.org/10.1034/j.1399-3046.2002.02003.x] [PMID: 12100503]
[40]
Jordan SC, Pescovitz MD. Presensitization: the problem and its management. Clin J Am Soc Nephrol 2006; 1(3): 421-32.
[http://dx.doi.org/10.2215/CJN.01651105] [PMID: 17699241]
[41]
Stroopinsky D, Katz T, Rowe JM, Melamed D, Avivi I. Rituximab-induced direct inhibition of T-cell activation. Cancer Immunol Immunother 2012; 61(8): 1233-41.
[http://dx.doi.org/10.1007/s00262-011-1168-2] [PMID: 22249775]
[42]
De Greef E, Avitzur Y, Grant D, et al. Infliximab as salvage therapy in paediatric intestinal transplant with steroid- and thymoglobulin-resistant late acute rejection. J Pediatr Gastroenterol Nutr 2012; 54(4): 565-7.
[http://dx.doi.org/10.1097/MPG.0b013e3182293d73] [PMID: 21694633]
[43]
Schaefer N, Tahara K. Websky Mv, Kalff JC, Hirner A, Türler A. Acute rejection in allogeneic rodent small bowel transplantation causes smooth muscle dysfunction via an inflammatory response within the intestinal muscularis. Transplant Proc 2006; 38(6): 1792-3.
[http://dx.doi.org/10.1016/j.transproceed.2006.05.047] [PMID: 16908282]
[44]
Schaefer N, Tahara K, Websky MV, et al. Acute rejection and the muscularis propria after intestinal transplantation: the alloresponse, inflammation, and smooth muscle function. Transplantation 2008; 85(10): 1465-75.
[http://dx.doi.org/10.1097/TP.0b013e31816fc189] [PMID: 18497688]
[45]
Imagawa DK, Millis JM, Olthoff KM, et al. The role of tumor necrosis factor in allograft rejection. II. Evidence that antibody therapy against tumor necrosis factor-alpha and lymphotoxin enhances cardiac allograft survival in rats. Transplantation 1990; 50(2): 189-93.
[http://dx.doi.org/10.1097/00007890-199008000-00003] [PMID: 2200173]
[46]
Farmer DG, McDiarmid SV, Kuniyoshi J, Robert ME, Shaked A, Busuttil RW. Intragraft expression of messenger RNA for interleukin-6 and tumor necrosis factor-alpha is a predictor of rat small intestine transplant rejection. J Surg Res 1994; 57(1): 138-42.
[http://dx.doi.org/10.1006/jsre.1994.1121] [PMID: 8041128]
[47]
Pech T, Fujishiro J, Finger T, et al. Combination therapy of tacrolimus and infliximab reduces inflammatory response and dysmotility in experimental small bowel transplantation in rats. Transplantation 2012; 93(3): 249-56.
[http://dx.doi.org/10.1097/TP.0b013e31823e7abb] [PMID: 22167049]
[48]
Nagai S, Rizzari M, Muszkat Y, et al. Comparison of induction and maintenance immunosuppression regimens in intestinal and multivisceral transplantation: na anaysis of the UNOS registry. American Transplant Congress.
[49]
Smith JM, Weaver T, Skeans MA, et al. OPTN/SRTR 2017 Annual Data Report: Intestine. Am J Transplant 2019; 19(Suppl. 2): 284-322.
[http://dx.doi.org/10.1111/ajt.15277] [PMID: 30811888]
[50]
Vakras G. Intestinal transplantation. Organ donation and transplantation - current status and futures challenges. IntechOpen 2018; 289-311.
[51]
Liapis G, Boletis J, Skalioti C, et al. Histological spectrum of mycophenolate mofetil-related colitis: association with apoptosis. Histopathology 2013; 63(5): 649-58.
[http://dx.doi.org/10.1111/his.12222] [PMID: 24025088]
[52]
Fishbein TM, Florman S, Gondolesi G, et al. Intestinal transplantation before and after the introduction of sirolimus. Transplantation 2002; 73(10): 1538-42.
[http://dx.doi.org/10.1097/00007890-200205270-00004] [PMID: 12042637]
[53]
Florman S, Gondolesi G, Schiano T, et al. Improved results in small bowel transplantation using sirolimus. Transplant Proc 2002; 34(3): 936.
[http://dx.doi.org/10.1016/S0041-1345(02)02678-7] [PMID: 12034247]
[54]
Lauro A, Dazzi A, Ercolani G, et al. Rejection episodes and 3-year graft survival under sirolimus and tacrolimus treatment after adult intestinal transplantation. Transplant Proc 2007; 39(5): 1629-31.
[http://dx.doi.org/10.1016/j.transproceed.2007.02.067] [PMID: 17580204]
[55]
Kubal CA, Mangus RS, Vianna RM, et al. Impact of positive flow cytometry crossmatch on outcomes of intestinal/multivisceral transplantation: role anti-IL-2 receptor antibody. Transplantation 2013; 95(9): 1160-6.
[http://dx.doi.org/10.1097/TP.0b013e3182888df0] [PMID: 23435456]
[56]
Gerlach UA, Schoenemann C, Lachmann N, Koch M, Pascher A. Salvage therapy for refractory rejection and persistence of donor-specific antibodies after intestinal transplantation using the proteasome inhibitor bortezomib. Transpl Int 2011; 24(5): e43-5.
[http://dx.doi.org/10.1111/j.1432-2277.2010.01203.x] [PMID: 21155900]
[57]
Farmer DG, Venick RS, Colangelo J, et al. Pretransplant predictors of survival after intestinal transplantation: analysis of a single-center experience of more than 100 transplants. Transplantation 2010; 90(12): 1574-80.
[http://dx.doi.org/10.1097/TP.0b013e31820000a1] [PMID: 21107306]
[58]
Kubal C, Mangus R, Saxena R, et al. Prospective monitoring of donor-specific Anti-HLA antibodies after intestine/multivisceral transplantation: significance of de novo antibodies. Transplantation 2015; 99(8): e49-56.
[http://dx.doi.org/10.1097/TP.0000000000000614] [PMID: 25769071]
[59]
Lauro A, Marino IR. Uptodat on chronic rejection after intestinal transplant: an overview from experimental settings to clinical outcomes. Exp Clin Transplant 2019; 17(Suppl. 1): 18-30.
[http://dx.doi.org/10.6002/ect.MESOT2018.L32] [PMID: 30777519]
[60]
Bond G, Reyes J, Mazariegos G, et al. The impact of positive T-cell lymphocytotoxic crossmatch on intestinal allograft rejection and survival. Transplant Proc 2000; 32(6): 1197-8.
[http://dx.doi.org/10.1016/S0041-1345(00)01181-7] [PMID: 10995904]
[61]
Kornberg A. Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation. World J Hepatol 2015; 7(11): 1494-508.
[http://dx.doi.org/10.4254/wjh.v7.i11.1494] [PMID: 26085909]
[62]
Schwab I, Nimmerjahn F. Intravenous immunoglobulin therapy: how does IgG modulate the immune system? Nat Rev Immunol 2013; 13(3): 176-89.
[http://dx.doi.org/10.1038/nri3401] [PMID: 23411799]
[63]
Zinn MD, L’Ecuyer TJ, Fagoaga OR, Aggarwal S. Bortezomib use in a pediatric cardiac transplant center. Pediatr Transplant 2014; 18(5): 469-76.
[http://dx.doi.org/10.1111/petr.12300] [PMID: 24931171]
[64]
Danylesko I, Bukauskas A, Paulson M, et al. Anti-α4β7 integrin monoclonal antibody (vedolizumab) for the treatment of steroid-resistant severe intestinal acute graft-versus-host disease. Bone Marrow Transplant 2019; 54(7): 987-93.
[http://dx.doi.org/10.1038/s41409-018-0364-5] [PMID: 30356163]
[65]
Fløisand Y, Lundin KEA, Lazarevic V, et al. Targeting integrin α4β7 in steroid-refractory intestinal Graft-versus-host disease. Biol Blood Marrow Transplant 2017; 23(1): 172-5.
[http://dx.doi.org/10.1016/j.bbmt.2016.10.009] [PMID: 27777142]
[66]
Beduschi T, Garcia J, Jebrock J, et al. Vedolizumab for the treatment of refractory severe rejection in intestinal transplantation. TRANSPLANTATION 2017 Jun; Volume: 101(Issue: 6): S59-9.Supplement: 2.
[http://dx.doi.org/10.1097/01.tp.0000521364.18534.8f]
[67]
Ceulemans LJ, Braza F, Monbaliu D, et al. The Leuven immunomodulatory protocol promotes t-regulatory cells and substantially prolongs survival after first intestinal transplantation. Am J Transplant 2016; 16(10): 2973-85.
[http://dx.doi.org/10.1111/ajt.13815] [PMID: 27037650]
[68]
Beduschi T, Garcia J, Lugo-Baruqui J, et al. Everolimus with low dose tacrolimus in intestinal transplantation. American J Transplantation 2015; 15(Suppl: 3: SI).

Rights & Permissions Print Cite
Article Metrics
32
2
World Health Day
© 2024 Bentham Science Publishers | Privacy Policy