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With full details described elsewhere, immunosuppression was tacrolimus-based in all recipients (3). In group I recipients, cyclophosphamide or daclizumab was added as induction therapy http://www.selleckchem.com/products/gsk1120212-jtp-74057.html to the immunosuppression protocol in 13 (19%) and 43 (61%) were pretreated (preconditioned) with rATG or alemtuzumab as an antilymphocyte depleting agent. None of group III patients received induction therapy and 19 (79%) were enrolled in the preconditioning protocol. Methylprednisolone boluses were used for induction and treatment of rejection with a mean (g/patient) of 6 �� 0.4 and 5 �� 0.6, respectively. With 16 (23%) of group I and 2 (8%) of group III recipients being completely off glucocorticoids at time of posttransplant BMD studies, the daily maintenance prednisone dose (mg) was 11 �� 1 and 14 �� 2, respectively. OKT3 and rATG or alemtuzumab were used to treat steroid-resistant rejection in 81% of group I and 58% of group III. In addition to immunosuppressive drug therapy, most intestinal recipients received long-term proton pump inhibitors, ursodeoxycholic acid and other http://www.selleck.cn/products/pd-1-pd-l1-inhibitor-2.html medications include antidiarrheal, antihypertensive and antimicrobial agents. Patients with hypercoagulable disorders were anticoagulated for life with low-molecular weight heparin before and early after transplantation. After recovery of the intestinal allograft absorptive functions, heparin treatment was replaced with oral warfarin. Full details of pre- and postoperative management is described elsewhere (3,6,9�C11). Assessment of BMD (g/cm2) of the posterior-anterior (PA), lumbar spine (L1-L4) and hip (femoral neck and total hip) was performed by Hologic Discovery? DXA (Hologic, Inc., Bedford, http://www.selleckchem.com/products/MDV3100.html MA, USA). The BMD was expressed as a standard deviation score (Z-score). All BMD assessments were performed by a certified technician at the Osteoporosis Prevention and Treatment Center, Montefiore University Hospital, Pittsburgh, PA. Precision errors of scans in patients with low bone mass were 1.2% for the total hip, 1.9% for the femoral neck and 1.5% for the PA spine (12). The serum levels of parathyroid hormone (PTH), vitamin D metabolites and total calcium were measured in all patients at the time DXA scan was performed. Intact PTH (1�C84) was measured with a chemiluminescence assay (Bayer Centaur PTH Immunoassays, Bayer, Tarrytown, NY, USA) with a normal range of 10�C65 pg/mL. The 25-hydroxy-vitamin D [25(OH) D] was measured by Radio Immune Assay (RIA Immunodiagnostic Systems, Boldon Business Park, UK). With a normal range of 25�C100 ng/mL, a level