Rejection episodes and 3-year graft survival under sirolimus and tacrolimus treatment after adult intestinal transplantation.
OBJECTIVE
Mammalian target of rapamycin (mTOR) inhibitors have been recently introduced in clinical practice after intestinal transplantation. We focused on Sirolimus (Rapamycin) to examine effects on rejection and graft survival following intestinal transplantation.


METHODS
Twenty isolated intestinal recipients and 5 multivisceral patients (2 with liver) in our series were divided into 3 groups: patients started on Sirolimus (because of nephrotoxicity or biopsy-proven rejection), who continued therapy longer than 3 months (n = 11); patients started on Sirolimus (because of nephrotoxicity or biopsy-proven rejection), who received therapy less than 3 months because of side effects (n = 4); and a control group, who never received rapamycin (n = 10).


RESULTS
During prolonged treatment combined with Tacrolimus (Prograf), both Sirolimus groups showed a decreased number of acute cellular rejections (P < .01). Cumulative 3-year graft and patient survival rates were 81% in the Sirolimus greater than 3 months group, 100% in the Sirolimus less than 3 months group, and 80% and 90% in the control group, respectively (P = .63 and P = .62).


CONCLUSIONS
In our experience, the use of mTOR-inhibitors in combination with calcineurin-inhibitors seemed to be more effective than monotherapy to reduce the number of rejections. Side effects can limit its use as maintenance therapy.
Lauro
A
A
U.O. Chirurgia dei Trapianti di Fegato e Multiorgano, University of Bologna, Policlinico S. Orsola-Malpighi, Massarenti no. 9, Bologna 40138, Italy. augustola@yahoo.com
Dazzi
A
A
Ercolani
G
G
Zanfi
C
C
Golfieri
L
L
Amaduzzi
A
A
Cucchetti
A
A
La Barba
G
G
Grazi
G L
GL
D'Errico
A
A
Vivarelli
M
M
Cescon
M
M
Varotti
G
G
Del Gaudio
M
M
Ravaioli
M
M
Di Simone
M
M
Faenza
S
S
Pironi
L
L
Pinna
A D
AD
D000328:Adult; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007422:Intestines / Q000637:transplantation*; D011494:Protein Kinases / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016019:Survival Analysis; D058570:TOR Serine-Threonine Kinases; D016559:Tacrolimus / Q000627:therapeutic use*; D014781:Viscera / Q000637:transplantation
D007166:Immunosuppressive Agents; D011494:Protein Kinases; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus; D016559:Tacrolimus