BIOMAT Database Logo BIOMAT Database Logo

A single center's clinical experience with quadruple immunosuppression including ATG or IL2 antibodies and mycophenolate mofetil in simultaneous pancreas-kidney transplants. 2000

U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Department of Surgery, Ghent University Hospital, Belgium. uwe.hesse@rug.ac.be

Acute rejection remains a major problem in simultaneous pancreas-kidney (SPK) transplant and occurs in 60-100% of the cases. With the introduction of mycophenolate mofetil (MMF) replacing azathioprine (AZA) as a basis immunosuppressant, reduced rates of rejection have been reported. This study investigates the frequency and clinical relevance of allograft rejection in SPK patients receiving antithymocyte globulin (ATG) or Basiliximab induction therapy and cyclosporine Neoral (CyA), MMF, steroid basis immunosuppression. Between December 1996 and October 1999, 21 consecutive patients (15 males, 6 females) received a SPK transplant at our institution with a mean +/- standard deviation (SD) age of 42 +/- 6 yr. Of these, 14 patients were treated with anti-thymocyte globulin (ATG) Fresenius (rabbit) 3-5 mg/kg for 6 +/- 2 d, cyclosporine Neoral (CyA) (trough levels 350-400 ng/mL), MMF 3 g/d and low dose steroid therapy. Seven SPK patients were treated with Basiliximab (Simulect, Novartis 20 mg on d 0 and d 4 post-transplant) instead of ATG. The patients had an average human leucocyte antigen (HLA) mismatch of 3.9/6 and a negative cross match. All patients remained on triple drug therapy. Three patients were switched to tacrolimus instead of Neoral for CyA intolerance. The mean +/- SD cold ischemia time (CIT) of the organs was 10.1 +/- 2.4 h for the pancreas and 10.5 +/- 2.6 h for the kidney. RESULTS Biopsy-proven rejection occurred in the kidney of 1 ATG patient (8%), which responded to steroid bolus therapy. One of the patients (14%) with Basiliximab induction developed renal allograft rejection, which was resolved after a 6-d course of anti-CD3 mAb (OKT3) treatment. All patients (100%) were free from rejection in the pancreas, as measured by urine amylase levels and glycemic control without the need for exogenous insulin with a mean glycosylated hemoglobin (HBA1C) of 5.1 +/- 0.7%, and serum creatinine with a mean of 1.24 +/- 0.24 mg/dL in a mean follow-up period of 17 +/- 15 months (median 12, range 2 37). CONCLUSIONS Triple drug immunosuppression including cyclosporine, MMF and low dose steroids with ATG or interleukin 2 (IL2) receptor antibodies induction therapy appears to be a very suitable immunosuppressive regimen for combined pancreas-kidney transplant (PKT) with a marked reduction in the incidence of rejection.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D008297 Male Males
D009173 Mycophenolic Acid Compound derived from Penicillium stoloniferum and related species. It blocks de novo biosynthesis of purine nucleotides by inhibition of the enzyme inosine monophosphate dehydrogenase (IMP DEHYDROGENASE). Mycophenolic acid exerts selective effects on the immune system in which it prevents the proliferation of T-CELLS, LYMPHOCYTES, and the formation of antibodies from B-CELLS. It may also inhibit recruitment of LEUKOCYTES to sites of INFLAMMATION. Cellcept,Mycophenolate Mofetil,Mycophenolate Mofetil Hydrochloride,Mycophenolate Sodium,Mycophenolic Acid Morpholinoethyl Ester,Myfortic,RS 61443,RS-61443,Sodium Mycophenolate,Mofetil Hydrochloride, Mycophenolate,Mofetil, Mycophenolate,Mycophenolate, Sodium,RS61443
D011993 Recombinant Fusion Proteins Recombinant proteins produced by the GENETIC TRANSLATION of fused genes formed by the combination of NUCLEIC ACID REGULATORY SEQUENCES of one or more genes with the protein coding sequences of one or more genes. Fusion Proteins, Recombinant,Recombinant Chimeric Protein,Recombinant Fusion Protein,Recombinant Hybrid Protein,Chimeric Proteins, Recombinant,Hybrid Proteins, Recombinant,Recombinant Chimeric Proteins,Recombinant Hybrid Proteins,Chimeric Protein, Recombinant,Fusion Protein, Recombinant,Hybrid Protein, Recombinant,Protein, Recombinant Chimeric,Protein, Recombinant Fusion,Protein, Recombinant Hybrid,Proteins, Recombinant Chimeric,Proteins, Recombinant Fusion,Proteins, Recombinant Hybrid
D005229 Fatty Acids, Monounsaturated Fatty acids which are unsaturated in only one position. Monounsaturated Fatty Acid,Acid, Monounsaturated Fatty,Acids, Monounsaturated Fatty,Fatty Acid, Monounsaturated,Monounsaturated Fatty Acids
D005260 Female Females
D005916 Globulins A group of proteins that are salt-soluble and form a large fraction of BLOOD PROTEINS. There are three types of globulins, ALPHA-GLOBULINS, BETA-GLOBULINS, and GAMMA-GLOBULINS, which are distinguished from one another by their degree of electrophoretic mobility. Globulin
D006084 Graft Rejection An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. Transplant Rejection,Rejection, Transplant,Transplantation Rejection,Graft Rejections,Rejection, Graft,Rejection, Transplantation,Rejections, Graft,Rejections, Transplant,Rejections, Transplantation,Transplant Rejections,Transplantation Rejections
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077552 Basiliximab A chimeric murine-human monoclonal antibody that functions as an INTERLEUKIN 2 RECEPTOR antagonist by binding to the alpha chain (CD25 ANTIGEN) of the interleukin-2 receptor on the surface of activated T-LYMPHOCYTES. It is used in the prevention of acute graft rejection episodes in patients undergoing renal transplantation. CHI 621,SDZ CHI 621,Simulect

Related Publications

U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Single-center experience of 60 consecutive simultaneous pancreas-kidney transplants using mycophenolate mofetil and tacrolimus as primary maintenance immunotherapy.
January 1999, Transplantation proceedings,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Long-term experience with simultaneous kidney-pancreas transplantation with portal-enteric drainage and tacrolimus/mycophenolate mofetil-based immunosuppression.
January 2003, Clinical transplantation,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
The use of intravenous tacrolimus and mycophenolate mofetil as induction and maintenance immunosuppression in simultaneous pancreas--kidney recipients with previous transplants.
April 2001, Clinical transplantation,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Mycophenolate mofetil and tacrolimus as primary maintenance immunosuppression in simultaneous pancreas-kidney transplantation: initial experience in 50 consecutive cases.
February 1999, Transplantation,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
First results with a quadruple therapy regimen including tacrolimus and mycophenolate mofetil in patients after combined pancreas and kidney transplantation.
March 1998, Transplantation proceedings,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Tacrolimus/mycophenolate mofetil/steroid-based immunosuppression after pancreas-kidney transplantation with single shot antithymocyte globulin.
June 1998, Transplantation proceedings,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Mycophenolate mofetil immunosuppression in rat pancreas allotransplantation.
January 1996, The Journal of surgical research,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Daclizumab and ATG versus ATG in combination with tacrolimus, mycophenolate mofetil, and steroids in simultaneous [correction of simultaneus] pancreas-kidney transplantation: analysis of early outcome.
August 2002, Transplantation proceedings,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Observations on quadruple immunosuppression maintenance therapy using rapamycin, low-dose cyclosporine, mycophenolate mofetil, and prednisone following ATG induction.
September 2005, Transplantation proceedings,
U J Hesse, and R Troisi, and B Jacobs, and B Van Vlem, and B de Hemptinne, and R Van Holder, and F Vermassen, and J De Roose, and N Lameire
Mycophenolate mofetil/prednisolone/single-shot ATG with tacrolimus or cyclosporine in pancreas/kidney transplantation: first results of an ongoing prospective randomized trial.
January 1999, Transplantation proceedings,
Copied contents to your clipboard!