The First Collective Examination of Immunosuppressive Practices Among American Intestinal Transplant Centers.
The First Collective Examination of Immunosuppressive Practices Among American Intestinal Transplant Centers.
复制标题
DOI：
10.1097/txd.0000000000001512
复制
发表时间：
2023-09
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
--
作者：
与其他实体器官不同，肠移植（ITx）没有标准化的治疗算法。我们建立了一个由美国ITx中心组成的联盟来评估当前的做法。所有在过去3年中执行ITx的美国中心都被邀请参加。作为一个联盟，我们提出了一些问题，以评估和收集每个机构的数据。对数据进行了汇编和分析。10家临床试验机构参与了研究，在过去3年中进行了211次ITx（范围：3 - 46;平均21.1）。诱导方案差异很大。胸腺球蛋白是最常见的，用于多名患者（85/211; 40.3%），但没有共识方案。同样，治疗急性细胞排斥反应、抗体介导的排斥反应和移植物抗宿主病的方案在各中心之间也存在显著差异。我们还评估了维持免疫抑制方案、脱敏方案、雷帕霉素使用的哺乳动物靶点、抗代谢药使用和移植后监测实践的差异。维持他克莫司水平、造口存在和内镜检查频率与排斥事件的差异无关。治疗与结果（包括移植物和患者生存率）之间的连续性相关性不是这种最初合作的意图，并且由于缺乏患者水平的数据和混杂因素的存在而无法实现。然而，我们确定了各种诱导策略后排斥事件的趋势，需要在我们随后的合作中进一步调查。这一初步合作揭示了美国ITx中心实践的极端异质性。未来的合作将探索患者水平的数据，按年龄和移植类型（离体肠与多器官）分层，以探索治疗方案与结局之间的关联。
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. 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. 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. 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.