The First Collective Examination of Immunosuppressive Practices Among American Intestinal Transplant Centers

Joshua Weiner, MD; Nathaly Llore, MD; Dylan Ormsby; Masato Fujiki, MD; Maria Cristina Segovia, MD; Mark Obri, MD; Syed-Mohammed Jafri, MD; Jedson Liggett, MD; Alexander H.K. Kroemer, MD, PhD; Cal Matsumoto, MD; Jang Moon, MD; Pierpaolo Di Cocco, MD; Gennaro Selvaggi, MD; Jennifer Garcia, MD; Armando Ganoza, MD; Ajai Khanna, MD; George Mazariegos, MD; Danielle Wendel, MD; Jorge Reyes, MD; for The American Intestinal Transplantation Working Group

doi:10.1097/TXD.0000000000001512

Transplantation Direct (Sep 2023)

The First Collective Examination of Immunosuppressive Practices Among American Intestinal Transplant Centers

Joshua Weiner, MD,
Nathaly Llore, MD,
Dylan Ormsby,
Masato Fujiki, MD,
Maria Cristina Segovia, MD,
Mark Obri, MD,
Syed-Mohammed Jafri, MD,
Jedson Liggett, MD,
Alexander H.K. Kroemer, MD, PhD,
Cal Matsumoto, MD,
Jang Moon, MD,
Pierpaolo Di Cocco, MD,
Gennaro Selvaggi, MD,
Jennifer Garcia, MD,
Armando Ganoza, MD,
Ajai Khanna, MD,
George Mazariegos, MD,
Danielle Wendel, MD,
Jorge Reyes, MD,
for The American Intestinal Transplantation Working Group

Affiliations

Joshua Weiner, MD: 1 Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY.
Nathaly Llore, MD: 1 Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY.
Dylan Ormsby: 1 Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY.
Masato Fujiki, MD: 2 Department of Surgery, Cleveland Clinic, Cleveland, OH.
Maria Cristina Segovia, MD: 3 Department of Medicine, Duke University Medical Center, Durham, NC.
Mark Obri, MD: 4 Department of Medicine, Henry Ford Hospital, Detroit, MI.
Syed-Mohammed Jafri, MD: 4 Department of Medicine, Henry Ford Hospital, Detroit, MI.
Jedson Liggett, MD: 5 MedStar Georgetown Transplant Institute, Washington, DC.
Alexander H.K. Kroemer, MD, PhD: 5 MedStar Georgetown Transplant Institute, Washington, DC.
Cal Matsumoto, MD: 5 MedStar Georgetown Transplant Institute, Washington, DC.
Jang Moon, MD: 6 Department of Surgery, Mount Sinai Medical Center, New York, NY.
Pierpaolo Di Cocco, MD: 7 Department of Surgery, University of Illinois Hospital, Chicago, IL.
Gennaro Selvaggi, MD: 8 Miami Transplant Institute, University of Miami Jackson Memorial Hospital, Miami, FL.
Jennifer Garcia, MD: 8 Miami Transplant Institute, University of Miami Jackson Memorial Hospital, Miami, FL.
Armando Ganoza, MD: 9 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Ajai Khanna, MD: 9 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
George Mazariegos, MD: 9 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Danielle Wendel, MD: 10 Departments of Surgery and Pediatrics, University of Washington Medical Center/Seattle Children’s Hospital, Seattle, WA.
Jorge Reyes, MD: 10 Departments of Surgery and Pediatrics, University of Washington Medical Center/Seattle Children’s Hospital, Seattle, WA.
for The American Intestinal Transplantation Working Group

DOI: https://doi.org/10.1097/TXD.0000000000001512
Journal volume & issue: Vol. 9, no. 9
p. e1512

Abstract

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Background. Unlike other solid organs, no standardized treatment algorithms exist for intestinal transplantation (ITx). We established a consortium of American ITx centers to evaluate current practices. Methods. All American centers performing ITx during the past 3 y were invited to participate. As a consortium, we generated questions to evaluate and collect data from each institution. The data were compiled and analyzed. Results. Ten centers participated, performing 211 ITx during the past 3 y (range, 3–46; mean 21.1). Induction regimens varied widely. Thymoglobulin was the most common, used in the plurality of patients (85/211; 40.3%), but there was no consensus regimen. Similarly, regimens for the treatment of acute cellular rejection, antibody-mediated rejection, and graft-versus-host disease varied significantly between centers. We also evaluated differences in maintenance immunosuppression protocols, desensitization regimens, mammalian target of rapamycin use, antimetabolite use, and posttransplantation surveillance practices. Maintenance tacrolimus levels, stoma presence, and scoping frequency were not associated with differences in rejection events. Definitive association between treatments and outcomes, including graft and patient survival, was not the intention of this initial collaboration and is prevented by the lack of patient-level data and the presence of confounders. However, we identified trends regarding rejection episodes after various induction strategies that require further investigation in our subsequent collaborations. Conclusions. This initial collaboration reveals the extreme heterogeneity of practices among American ITx centers. Future collaboration will explore patient-level data, stratified by age and transplant type (isolated intestine versus multivisceral), to explore the association between treatment regimens and outcomes.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

About the journal