Initial results of solitary pancreas transplants performed without regard to donor/recipient HLA mismatching

被引:7
作者
Gruber, SA
Katz, S
Kaplan, B
Clark, JH
Chen, PC
El-Sabrout, R
Kerman, RH
机构
[1] Univ Texas, Hlth Sci Ctr, Div Immunol & Organ Transplantat, Dept Surg, Houston, TX 77030 USA
[2] Univ Texas, Hlth Sci Ctr, Dept Pathol & Lab Med, Houston, TX 77030 USA
[3] Univ Texas, Hlth Sci Ctr, Dept Radiol, Houston, TX 77030 USA
关键词
D O I
10.1097/00007890-200007270-00028
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. We hypothesized that solitary pancreas transplants could be performed successfully even in the presence of poor HLA matching if an aggressive approach were taken with regard to immunosuppressive protocol and the performance of allograft-biopsy. Methods. Seven pancreas-after-kidney transplants and seven pancreas transplants alone were performed without consideration given to the degree of HLA mismatching (MM) using tacrolimus (FK506)/mycophenolate mofetil (MMF)/prednisone maintenance therapy. Mean (+/-SD) total HLA MM was 4.8+/-1.2. All patients mere followed for at least 6 months. The first four cases were induced with ATGAM for 7 to 10 days. In the remaining 10 cases, an ultrasound-guided percutaneous needle biopsy was attempted on a protocol basis 10 days after completing induction with OKT3 for 7 (n=2) or 14 (n=8) days. Results, Overall patient survival, graft survival, and incidence of acute rejection requiring treatment were 86, 79, and 50%, respectively, Two patients receiving ATGAM developed grade III-IV rejection at 3 weeks. Both patients receiving OKT3 for 7 days developed early grade III rejection. However, only three of eight patients receiving OKT3 for 14 days developed rejection requiring treatment. Protocol biopsy was successfully performed in six of seven patients and uncovered three cases of otherwise undetectable grade III-IV rejection. Conclusions. Although based on a small number of cases, our results suggest that solitary pancreas transplants with a poor HLA match can be performed with an acceptable rejection incidence and graft survival rate using an OKT3/FK506/MMF/prednisone regimen with protocol biopsy.
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页码:388 / 391
页数:4
相关论文
共 10 条
[1]  
Bartlett ST, 1996, ANN SURG, V224, P440, DOI 10.1097/00000658-199610000-00003
[2]   Pancreas after kidney transplantation: HLA mismatch does not preclude success [J].
Basadonna, GP ;
Auersvald, LA ;
Oliveira, SC ;
Friedman, AL ;
Lorber, MI .
TRANSPLANTATION PROCEEDINGS, 1997, 29 (1-2) :667-667
[3]   Evaluation of pancreas transplant needle biopsy - Reproducibility and revision of histologic grading system [J].
Drachenberg, CB ;
Papadimitriou, JC ;
Klassen, DK ;
Racusen, LC ;
HoehnSaric, EW ;
Weir, MR ;
Kuo, PC ;
Schweitzer, EJ ;
Johnson, LB ;
Bartlett, ST .
TRANSPLANTATION, 1997, 63 (11) :1579-1586
[4]   PERCUTANEOUS BIOPSY OF PANCREAS TRANSPLANTS [J].
GABER, AO ;
HATHAWAY, D ;
GABER, LW ;
SHOKOUHAMIRI, MH .
TRANSPLANTATION, 1992, 54 (03) :548-567
[5]  
GRUBER SA, 1999, INTENS CARE MED, P2173
[6]  
Gruessner AC, 1998, CLIN TRANS, P53
[7]   Solitary pancreas transplantation for nonuremic patients with labile insulin-dependent diabetes mellitus [J].
Gruessner, RWG ;
Sutherland, DER ;
Najarian, JS ;
Dunn, DL ;
Gruessner, AC .
TRANSPLANTATION, 1997, 64 (11) :1572-1577
[8]   Mycophenolate mofetil in pancreas transplantation [J].
Gruessner, RWG ;
Sutherland, DER ;
Drangstveit, MB ;
Wrenshall, L ;
Humar, A ;
Gruessner, AC .
TRANSPLANTATION, 1998, 66 (03) :318-323
[9]   Sequential pancreas after kidney transplantation: Is anti-lymphocyte induction therapy needed? [J].
Stratta, RJ .
TRANSPLANTATION PROCEEDINGS, 1998, 30 (04) :1549-1551
[10]   Solitary pancreas transplants: A new era [J].
Sutherland, DER ;
Gruessner, RWG ;
Najarian, JS ;
Gruessner, AC .
TRANSPLANTATION PROCEEDINGS, 1998, 30 (02) :280-281