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Clinical immunosuppression for intestinal transplantation

Purpose of reviewThis article describes the recent developments relevant to immunosuppression and immunomodulation of recipients of intestinal transplant allografts. Recent findingsClearly, historical immunosuppressive therapies based on either azathioprine or cyclosporine were not sufficient to facilitate successful intestinal transplantation in humans. Most successful immunosuppressive regimens currently are based on tacrolimus and steroid therapy. Several centers are adding third agents to this cocktail to improve success. Still, rejection, infection, and immunosuppressive-related side effects are common. These issues have driven efforts towards the development of newer, novel immunotherapeutic protocols. The most promising current protocols involve the addition of the interleukin-2 receptor antagonist, sirolimus, rabbit antithymocyte globulin, and alemtuzumab. The most recent data regarding these agents are reviewed herein. SummaryThe field of intestinal transplantation has witnessed significant growth over the past decade due in part to advances in immunosuppression. Today, there are several promising immunosuppressive regimens that facilitate successful intestinal transplantation with low rejection rates and excellent graft survival. Continued efforts to optimize immunosuppression and immunomodulation after intestinal transplantation are needed.