Recent Advances in Intestinal Transplantation

New Immunosuppression Protocols Increase Quality of Life

The first hurdle in the early years of transplantation was lowering the rate of organ rejection. This was accomplished with immunosuppression protocols that included significant doses of anti-rejection drugs and multiple drug therapies.

“That seemed reasonable,” said George V. Mazariegos, MD, co-director of Pediatric Liver and Intestine Transplantation at Children’s Hospital of Pittsburgh of UPMC. “But what it resulted in was that while some patients were free from rejection, they were suffering from the complications of their medicines.”

As rejection rates fell, doctors at Children’s began rethinking the use of large amounts of anti-rejection drugs, which can have serious side effects – such as increasing the risk of infection. Early in 2002, Children’s began using an immunosuppression protocol that eliminates the need for steroids and reduces the required dosage of Prograf (tacrolimus), the primary anti-rejection drug.

Reduced Anti-rejection Drugs Improves Outcomes

Fewer incidents of organ rejection have occurred under the new protocol and several signs point to improved quality of life during recovery. Avoiding long-term use of steroids avoids prednisone-related complications, such as:

  • “Moon-face” (Cushingoid facies)
  • Increased acne in teenagers
  • Growth retardation
  • Weight gain
  • Mood swings
  • Osteoporosis
  • Glaucoma
  • Cataracts

“The children are getting out of the hospital sooner,” said Beverly Park, MSN, CRNP, clinical nurse specialist at Children’s Hospital. “They are having fewer complications from the anti-rejection drugs, particularly prednisone, because we aren’t using steroids anymore. Children who used to leave [the hospital] on 12 to 15 meds a day are now leaving on five to seven meds. And most of the meds are twice a day, so parents are spending less time each day preparing and giving medications –and the kids’ daily routine is interrupted by fewer medical interventions.”