Steroid-Free Therapy for Intestinal Transplant Patients

Transplant surgeons at UPMC Children’s Hospital of Pittsburgh began giving pediatric intestinal transplant patients a dose of the drug thymoglobulin before surgery at the suggestion of University of Pittsburgh transplant pioneer Thomas Starzl, MD. Young patients also receive a dose of thymoglobulin following transplant surgery. Prograf® is still used, but often in smaller doses.

Early outcomes are promising. As of May 2003, the graft survival rate of all pediatric patients who have undergone intestinal transplantation under the new immunosuppression protocol stood at 100 percent. Doctors are able to transplant patients without the routine use of steroids. Hospital stays are shorter and patients experience fewer side effects from immunosuppressants and other post-surgical complications.

“We’ve eliminated steroids from the management of these patients and it’s dramatically decreased the incidence of rejection, the severity of rejection, and has allowed us to minimize post-transplant immunosuppression early,” says George Mazariegos, MD, director of Pediatric Transplantation at Children’s Hospital of Pittsburgh. “Eliminating steroids has really impacted how these patients feel and will have an impact on their development, growth and ability to function as adults.”

Children’s Hospital is continuing to look for ways to further improve methods of preventing rejection and enhancing recovery. Research includes studying how suppressor cells, known as lymphocytes, behave under the new protocol to determine whether immunosuppression can be curtailed even sooner after transplantation.

Learn more about the History of Intestinal Transplantation.