title: Impact of induction therapy on bacterial infections and long-term outcome in adult intestinal and multivisceral transplantation: a comparison of two different induction protocols: daclizumab vs. alemtuzumab.
abstract: BACKGROUND
  Induction therapy with daclizumab or alemtuzumab has been recently introduced for intestinal transplantation; however, the impact of such induction therapy on bacterial infections remains to be clarified. The purpose of this study was to evaluate the impact of induction therapy on the incidence of bacterial infections and long-term patient survival.
  
  
  METHODS
  Over the past seven yr, we performed 39 intestinal (ITx) and multivisceral (MTVx) transplants in 38 adult patients. In the early period, daclizumab was used for induction, and tacrolimus and steroids were administered for maintenance [daclizumab and tacrolimus (DT) group; n = 11]. From 2002, we used alemtuzumab for induction, with low-dose tacrolimus maintenance [alemtuzumab and tacrolimus (AT) group; n = 23]. The incidence of bacterial infections and patient outcome were compared between the two groups.
  
  
  RESULTS
  There were no significant differences in recipient and donor demographics, procedure (ITx vs. MTVx), and cold and warm ischemic time between the two groups. Within 30 d after ITx, bacterial infections were observed in seven patients (64%) in the DT and in 14 patients (64%) in the AT group. Between 30 and 180 d after ITx, a total of 17 episodes of bacterial infections were observed in the DT and 26 episodes in the AT group. Three patients in the DT and eight in the AT group died, and all of the deaths were related to infectious complications except one each in DT and AT.
  
  
  CONCLUSIONS
  There was no difference in incidence of bacterial infections and long-term patient survival between the two groups.
authors.affiliation: Division of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. kimutaku@pedsurg.med.osaka-u.ac.jp
authors.forename: Takuya
authors.initials: T
authors.lastname: Kimura
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Chiara
authors.initials: C
authors.lastname: Zanfi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Dazzi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Matteo
authors.initials: M
authors.lastname: Zanello
authors.forename: Giuliano
authors.initials: G
authors.lastname: LaBarba
authors.forename: Loris
authors.initials: L
authors.lastname: Pironi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lazzarotto
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology*; D000077561:Daclizumab; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D000077561:Daclizumab