Immunosuppression Regimens for Intestinal Transplantation in Children

Pediatric intestinal transplant serves as the only definitive treatment for children with irreversible intestinal failure. Successful intestinal transplant hinges upon appropriate management of immunosuppression. The indications for intestinal transplant have changed over time. Immunosuppression regimens can be divided into induction and maintenance phases along with treatment of acute rejection. Intestinal transplant induction now often includes antithymocyte globulin or basiliximab in addition to corticosteroids. Maintenance regimens continue to be dominated by tacrolimus, with additional agents used to either decrease goal tacrolimus levels to limit toxicity or as an adjunct in sensitized patients. Careful monitoring can help to limit serious complications, such as rejection, infection, and malignancy. Future work will aim to decrease variation in practice and identify methods to determine optimal immunosuppression for a particular patient. Furthermore, there is a need for non-invasive monitoring of the intestinal graft and functional assessments of immunosuppression.

Automated summary

Pediatric intestinal transplant is the only definitive treatment for irreversible intestinal failure in children, and its success relies on appropriate management of immunosuppression. The indications for transplant have changed over time, and immunosuppression regimens consist of induction and maintenance phases as well as treatment for acute rejection. Current induction protocols often include antithymocyte globulin or basiliximab in addition to corticosteroids. Maintenance regimens are primarily dominated by tacrolimus, with additional agents used to adjust tacrolimus levels or as adjunct therapy for sensitized patients. Close monitoring is crucial to limit serious complications such as rejection, infection, and malignancy. Future research aims to standardize practice and find optimal immunosuppression methods for individual patients, as well as develop non-invasive monitoring and functional assessments of immunosuppression for intestinal grafts.