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.
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.
Kimura
Takuya
T
Division of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. kimutaku@pedsurg.med.osaka-u.ac.jp
Lauro
Augusto
A
Cescon
Matteo
M
Zanfi
Chiara
C
Dazzi
Alessandro
A
Ercolani
Giorgio
G
Grazi
Gian Luca
GL
Vivarelli
Marco
M
Ravaioli
Matteo
M
Del Gaudio
Massimo
M
Cucchetti
Alessandro
A
Zanello
Matteo
M
LaBarba
Giuliano
G
Pironi
Loris
L
Lazzarotto
Tiziana
T
Pinna
Antonio Daniele
AD
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
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D000077561:Daclizumab