Clinical outcomes of intestinal transplant recipients receiving maintenance basiliximab, sublingual tacrolimus and prednisone: A case series

Pierpaolo Di Cocco; Alessandro Martinino; Giulia Bencini; Rachel Christensen; Benito Valdepenas 3rd; Egor Petrochenkov; Stepan Akshelyan; Jorge Almario-Alvarez; Mario Spaggiari; Ivo Tzvetanov; Enrico Benedetti

doi:10.1016/j.humimm.2024.110787

Clinical outcomes of intestinal transplant recipients receiving maintenance basiliximab, sublingual tacrolimus and prednisone: A case series

Hum Immunol. 2024 Mar 12:110787. doi: 10.1016/j.humimm.2024.110787. Online ahead of print.

Affiliations

¹ Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
² Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: alessandro.martinino@gmail.com.
³ Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.

PMID: 38480040
DOI: 10.1016/j.humimm.2024.110787

Abstract

Introduction: Intestinal transplantation poses a unique challenge in the field of solid organ transplantation. The combination of tacrolimus and prednisone stands as the foundational cornerstone of maintenance immunosuppression in the field of intestinal transplantation. This case series aims to describe 1-year clinical outcomes of 5 intestinal transplant recipients who received a novel immunosuppression regimen consisting of monthly basiliximab, sublingual tacrolimus, and prednisone.

Methods: A retrospective analysis of patients who underwent intestinal transplantation in our center between January 01, 2020, and January 31, 2022, was conducted. Each recipient was followed for at least 1-year post-transplant. Recipient baseline demographics, clinical characteristics, and follow-up data were obtained from the electronic health records. Data collection included recipient demographics (age, sex, race/ethnicity, BMI), cause of intestinal failure, immunological data, infectiology data and treatment information.

Results: A total of five patients underwent intestinal transplantation, of which two males (40 %) and three females (60 %), with a median age of 20.1 years (17.4-28.8). The median (IQR) tacrolimus trough by month 1 was 10.4 (8.4-13.2) ng/mL. Subsequently, the median (IQR) tacrolimus troughs at specified periods are as follows, respectively: month 3: 10.2 (8.2-13.2) ng/mL; month 6: 8.4 (7.6-9.6) ng/mL; and month 12: 8.8 (6.2-9.8) ng/mL. Three patients (60.0 %) had biopsy proven rejection, but all of them had resolution after the optimization of immunosuppression. All patients were alive and had a functioning intestinal allograft at 1-year.

Conclusion: The combination of monthly basiliximab, sublingual tacrolimus, and prednisone is an effective novel maintenance immunosuppression in intestinal transplantation. A larger and more extended study duration would be necessary to thoroughly assess the safety and sustained benefits of the novel maintenance immunosuppression regimen.

Keywords: Basiliximab; Intestinal transplant; Tacrolimus.