Regimens for intestinal transplant immunosuppression

Purpose,of review The purpose of this review is to summarize the most recent findings and developments relevant to the immunosuppression of intestinal and multivisceral transplant allograft recipients. Recent findings Tacrolimus-based immunosuppression continues to be the cornerstone of anti-rejection medications for intestinal allograft recipients. Recent experience with both-induction and maintenance adjuncts continue to help determine the efficacy of such interventions. Improved outcomes with agents such as interleukin-2 receptor antagonists, sirolimus, alemtuzumab and more novel immune modulators such as infliximab have been reported recently. Investigations aimed at the inducation of donor specific tolerance (or 'prope-tolerance') continue to be an active area of clinical research in intestinal transplantation, but have yet to yield substantive results. Summary Intenstinal and multivisceral transplantation has become the treatment of choice for patients suffering from life-threatening complications of irreversible gut failure. Increasing exerpience in the diagnosis of rejection, identification of new viral pathogens, and improvements in the overall medical care of these patients has contributed to improvement in outcome over the past decade. Individual transplant programs performing intestinal transplantation tend to have their own immunosuppressive protocols, and have reported decreased rejection rates and improved graft survivals regardless of the specific drug combinations used.