Abstracts

SUSTAINED SURVIVAL AND GROWTH ADVANTAGES OF STEROID-FREE INTESTINAL TRANSPLANTATION AT 2-YEAR FOLLOW-UP

Rakesh Sindhi, Nandita Khera, Anita Nucci, Lori Kowalski, Graciela Perez, Kyle Soltys, Geoff Bond, Kareem Abu-Elmagd, Tamara Fazzolare, Lisa Remaley, Beverly Kosmach, Lynn Seward, Kim Haberman, George Mazariegos. University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Background/Purpose/Methods: Sequential cohort analysis was performed at 2 years for each of 94 consecutive small bowel (SBTx) recipients to compare late outcomes of conventional Tacrolimus (TAC)+steroids (n=45) and recent steroid-free TAC after rabbit, anti-human thymocyte globulin (rATG, n=49).

Results: rATG and TAC+steroid groups were similar in age (6.15.9 vs 4.94.9 yrs, p=NS) and M: F gender (28:21 vs 28:17, p=NS). Twice as many isolated SBTx recipients than recipients of combined liver-SBTx were in rATG group (SBTx 12/45, 36% vs 27/49, 55%, p=0.01). Compared with TAC+steroid group, rATG-treated patients demonstrated 1. Superior 2-year patient and graft survival (92 and 90% vs 67 and 62%, p=0.001). 2. Lower steroid use in recipients with functioning grafts at 12 and 24 months (36%, and 36% respectively) compared with 100% at similar time points in the TAC+steroid group (p<0.01), 3. Lower TAC levels (ng.ml) at 1 year (7.53.4 vs 13.55.4, p=0.001), and 2 years post-Tx (7.94.3 vs 105.6, p=NS), 4. Significantly less EBV-PTLD (4/49, 8% vs 10/45, 23%, p=0.011) and CMV disease (2/49, 6% vs 6/45, 13%, p=0.037). Predictors of graft loss in this small sample (logistic regression) were steroid use at 3 months (p=0.07, odd ratio 2.92, 95% CI 0.89, 9.61) and TAC levels at 1 year (p=0.067, odd ratio 1.1, 95% CI 0.99, 1.22). rATG group reached 137% of expected linear growth velocity vs 90% in TAC+steroid group. Mean z scores for linear growth were less negative for rATG subgroup receiving no steroids, than for rATG subgroup receiving steroids, or TAC+steroid group at 2 years (PreTx to 2-year values are -2.25 to -1.67, -2.96 to -2.59, and -2.28 to -2.02, respectively). These benefits occurred despite more frequent recurrent rejection in rATG-treated SBTx at 2 years (8/27, 30% vs 2/12, 17%, p=0.005). Although rATG-treated LSBTx patients experienced a higher incidence of liver rejection in the first year (12/21 vs 2/28, p=0.001), rejection of the SB in the second year was similar to that seen in TAC+steroid group among functioning grafts (2/21 vs 4/33, p=NS).

Conclusions: Steroid avoidance and Tacrolimus minimization leads to significantly greater survival in pediatric SBTx, largely due to reduced immunosuppressant morbidities. This is also associated with superior growth documented by anthropometric measurements.

Top Updated 9/20/06