A prospective study of XXXX versus CsA and @entity1707 ATG in a porcine model of small bowel transplantation.

@entity1707 @entity71358 @entity500 @entity205 @entity2132 @entity1140 @entity1211 @entity204 @entity617
Rejection remains a major barrier to successful bowel transplantation, and immunosuppressive protocols are far from standardized. In 88 nonrelated outbred @entity1707 , we compared the effects of two immunosuppressive regimens--one with @entity1140 , the other with @entity205 (CsA) and pig antithymocyte globulin (ATG)--on incidence and severity of rejection in the early, critical posttransplant period. Group A (n = 14) was nonimmunosuppressed (controls). Group B (n = 17) received @entity1707 ATG (10 mg/kg/day x 10 days), CsA (3 mg/kg/day), @entity617 (2 mg/kg/day), and @entity500 (2.5 mg/kg/day); @entity617 and @entity500 were each reduced by 50% at 8 and 15 days posttransplant. Trough CsA whole-blood concentrations were > or = 400 ng/ml for the first 7 days, > or = 200 ng/ml thereafter. Group C (n = 13) received @entity1140 (0.2 mg/kg/day) and @entity617 (2 mg/kg/day); @entity617 was reduced by 50% at 8 and 15 days. @entity1140 whole-blood concentrations were > or = 20 ng/ml. All immunosuppression in groups B and C was given intravenously. We performed orthotopic small bowel transplants with @entity1211 . Recipient bowel was resected distal to the second portion of the duodenum and proximal to the rectum at transplant; bowel continuity was restored by duodenojejunostomy; ileostomy was created distally to allow access for daily biopsies. We graded interstitial and vascular rejection separately, according to a scoring system (no, mild, moderate, and severe rejection). Rejection-free graft survivals at 7, 14, and 21 days posttransplant were 38%, 19%, and 0% in group A; 93%, 93%, and 62% in group B; and 100%, 91%, and 82% in group C (P < 0.001). Comparing rejection in the immunosuppressed groups, group C ( @entity1140 ) had a stronger tendency toward rejection than group B (CsA-ATG); significant differences between groups B and C were, however, noted only on individual days posttransplant, not over time. The @entity204 rate due to irreversible rejection was not significantly different in groups B and C (P = 0.8), but was significantly better in both of these immunosuppressed groups than in group A (P < 0.001). @entity1707 survival was significantly longer in group C than in B (P = 0.001) due to a lower infection rate in group C. Posttransplant serum @entity71358 levels did not correlate with rejection grades. @entity2132 was noted only in the skin in 29% of group A, 73% of group B, and 77% of group C @entity1707 ; liver and native bowel were not involved.(ABSTRACT TRUNCATED AT 400 WORDS)
