Anti-TNF-alpha therapy for acute rejection in intestinal transplantation.
BACKGROUND
We present our experience with infliximab rescue therapy for steroid- and OKT3-resistant rejection after intestinal transplantation (ITx).


METHODS
Twelve ITx and one multivisceral transplant recipients were immunosuppressed with tacrolimus, rapamycin, daclizumab, steroids (n = 10) or tacrolimus, campath, and steroids (n = 3).


RESULTS
In two patients, severe acute rejection did not resolve despite steroid bolus therapy plus 5 to 10 days of OKT3 treatment. Signs of moderate rejection persisted in the distal portions of the grafts. Treatment with infliximab, a chimeric anti-TNF-alpha antibody (four infusions of 3 mg/kg body weight), induced a complete remission of histological and clinical signs of rejection. Two further patients with steroid-resistant rejection received two courses of infliximab (3 mg/kg body weight) as antirejection therapy. All rejection episodes resolved completely.


CONCLUSIONS
Infliximab effectively treats steroid and OKT3 resistant acute rejection episodes of intestinal transplantations.
Pascher
A
A
Department of General and Transplantation Surgery, Charité, Campus Virchow Clinic, Berlin, Germany. andreas.pascher@charite.de
Klupp
J
J
Langrehr
J M
JM
Neuhaus
P
P
D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D007422:Intestines / Q000637:transplantation*; D016853:Muromonab-CD3 / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab