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Preliminary experience with Campath IH induction combinated with low-dose monotherapy of tacrolimus in small bowel transplantation
Pages: 810-813
Year: Issue:  11
Journal: Chinese Journal of Surgery

Keyword:  Organ transplantationSmall bowel transplantationImmunosuppressive gentsAcute rejectionCampath 1HTacrolimus;
Abstract: Objective To report preliminary experience of the protocol of combining Campath 1H induction with low-dose monotherapy of tacrolimus and no steroid in two cases of small bowel transplantation. Methods Campath 1H 30 mg was infused during the small bowel transplantation, and the patients were given 1 gram of methylpredniselone followed by the Campath 1H and another gram of methylpredniselone before reperfusion. Tacrolimus was infused just after the reperfusion. The tacrolimus was administered from vein first and then from gut tract, the blood tacrolimus level was controlled at 10 to 15 μg/L within the first 3 months after the operation, and reduced to 5 μg/L thereafter. Results The two recipients have survived more than 1 year, one received surgical closure of intestinal graft terminal stoma 13 months after the transplantation. One episode of indeterminate to mild acute rejection was verified by pathology through routine ileoscopical biopsy in each cases, and one episode of mild to moderate acute rejection occurred 8 months after the trausplantation, and the patients recovered after low dose or bolus steroid therapy. The peripheral lymphocyte counts and monocyte counts decreased greatly after Carnpath 1 H was given, and recovered very slowly thereafter. No sign of infection and graft versus host disease (GVHD) was found, and the grafted intestine achieved excellent function. The total parenteral nutrition was ceased on the day 21 and 14 after the operation, respectively, and the patients lived on oral intake to maintain nutrition status. Conclusions It's showed that the protocol combining Campath 1H induction with low-dose monotherapy of tacrolimus without steroid in small bowel transplantation can control graft rejection effectively without increasing the opportunity of infection, no sign of GVHD is found, and the grafted intestine could achieve excellent function.
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