title: Mortality after steroid-resistant acute cellular rejection and chronic rejection episodes in adult intestinal transplants: report from a single center in induction/preconditioning era.
abstract: Steroid-resistant acute cellular rejection (ACR) and chronic rejection (CR) are still major concerns after intestinal transplantation. We report our experience from a single center on 48 adults recipients using 49 grafts from 2001 to 2011, immunosuppressing them initially with daclizumab initially and later Alemtuzumab. Overall patient survival was 41.9% at 10 years while graft survival was 38.5%. The steroid-resistant ACR population of 14 recipients (28.5%) experienced 50% mortality mainly due to sepsis, while the five (8%) CR recipients, included two survivors. All but 1 graft was placed without a liver. CR was often preceded by ACR episodes. Mortality related to steroid-resistant ACR and CR still affects the intestinal transplant population despite induction/preconditioning, especially in the absence of a protective liver effect of the liver. New immunosuppressive strategies are needed.
authors.affiliation: Liver and Multiorgan Transplant Unit, St Orsola University Hospital, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: A
authors.initials: A
authors.lastname: Bagni
authors.forename: C
authors.initials: C
authors.lastname: Zanfi
authors.forename: S
authors.initials: S
authors.lastname: Pellegrini
authors.forename: A
authors.initials: A
authors.lastname: Dazzi
authors.forename: M
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: M
authors.initials: M
authors.lastname: Di Simone
authors.forename: G
authors.initials: G
authors.lastname: Ramacciato
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D006084:Graft Rejection / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007422:Intestines / Q000637:transplantation*; D013256:Steroids / Q000008:administration & dosage*; D019172:Transplantation Conditioning
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids