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 |
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Authors: | Takuya Kimura Augusto Lauro Matteo Cescon Chiara Zanfi Alessandro Dazzi Giorgio Ercolani Gian Luca Grazi Marco Vivarelli Matteo Ravaioli Massimo Del Gaudio Alessandro Cucchetti Matteo Zanello Giuliano LaBarba Loris Pironi Tiziana Lazzarotto Antonio Daniele Pinna |
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Institution: | Division of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;, Liver and Multiorgan Transplant Unit;and Department of Internal Medicine and Gastroenterology, Intestinal Failure Center;, Section of Microbiology, Department of Clinical and Experimental Medicine, S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy |
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Abstract: | Abstract: Introduction: 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. Patients and 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. Conclusion: There was no difference in incidence of bacterial infections and long‐term patient survival between the two groups. |
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Keywords: | alemtuzumab bacterial infection induction therapy intestinal transplantation small bowel transplantation |
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