(Message in Diabetes) #: 723118 S11/Tech & Theoretical (CIS:DIABETES) 08-May-97 17:38:20 Sb: TX news Fm: Bruce Beale-SYSOP 100345,3667 To: all Replies: 0 TID: 102490 Par: 0 Chd: 0 Sib: 0 UPMC Researchers Report Findings At National Transplant Meetings More than 50 papers are being presented by University of Pittsburgh Medical Center (UPMC) researchers at the American Society of Transplant Physicians (ASTP) 15th Annual Scientific Meeting May 10-14 and at the American Society of Transplant Surgeons (ASTS) 23rd Annual Scientific Meeting May 14-16 in Chicago. Results of three of these studies suggest improved outcomes for patients can be achieved by significantly reducing the number of drugs they take to control rejection, and in some cases, these drugs can be safely and completely eliminated altogether. Following is a summary of the three presentations. SURVIVAL BETTER FOR KIDNEY RECIPIENTS TAKEN OFF STEROIDS Weaning kidney transplant recipients off steroids is associated with excellent patient and graft survival, according to results of a study being presented at the ASTP meeting May 11 by Ron Shapiro, M.D., associate professor of surgery at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute. In addition, the study of patients whose immunosuppression was managed with the anti-rejection drug tacrolimus, or Prograf, found the incidence of rejection was much lower in patients who no longer took steroids. Surgeons routinely prescribe steroids, such as prednisone, in combination with other drugs to help protect a transplanted kidney from being rejected. However, steroids can cause side-effects ranging from weight gain, puffy cheeks and unwanted facial hair to more serious medical complications, such as muscle wasting, diabetes, osteoporosis and susceptibility to infections. In Dr. Shapiro's study, 289 out of 379 adult kidney patients were taken off prednisone between four and 36 months after receiving transplants from cadaveric or living-related donors. One-year patient survival was 99 percent in the group no longer taking steroids, compared to 91 percent of those still on steroids. At three years, patient survival was 98 and 80 percent, respectively. One- and three-year graft survival was 98 and 94 percent in the patients taken off steroids, compared to 77 and 50 percent in the patients not weaned, in whom there was also a higher incidence of rejection (73 percent). Rejection occurred in 43 percent of those taken off steroids. CONTACT: Lisa Rossi, 412-647-3555. CHILDREN CAN BE WEANED OF ANTI-REJECTION DRUGS Children who have received liver transplants can safely discontinue taking their immunosuppressant medication when clinically warranted, according to a study of 31 pediatric patients led by Jorge Reyes, M.D., associate professor of surgery, and colleagues at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute. The results, which are to be presented May 12 at the ASTP meeting, suggest some patients may not require a life-long regimen of anti-rejection medications with their accompanying side-effects. All of the patients in the study are alive, and 25, or 81 percent, remain off immunosuppression, one for more than seven years. Six of the patients in the study were weaned as part of a controlled protocol at the UPMC involving long-term adult and child transplant recipients. The others were withdrawn from their anti-rejection drugs -- either tacrolimus or cyclosporine -- because the immunosuppressants caused acute complications, including post- transplant lymphoproliferative disorder (tumors), viral and opportunistic infections and drug toxicity. These and other complications completely resolved after withdrawal of the drugs. Close surveillance and prompt intervention is necessary to manage rejection and avoid graft loss, says Dr. Reyes. A total of 41 adults and children have been weaned off drugs as part of the University of Pittsburgh study. CONTACT: Lisa Rossi, 412-647-3555, or Dean Walters, 412-692-6956. 08/05/97 (Message in Diabetes) #: 723119 S11/Tech & Theoretical (CIS:DIABETES) 08-May-97 17:39:00 Sb: Pancreas TX Fm: Bruce Beale-SYSOP 100345,3667 To: all Replies: 0 TID: 102491 Par: 0 Chd: 0 Sib: 0 This is heartening since the normal survival rate of pancreas tx rates is has not been very good so far NEW STRATEGY IMPROVES PANCREAS/KIDNEY RECIPIENTS' SURVIVAL Abandoning a standard drug treatment strategy used at most other transplant programs, surgeons at the UPMC were able to achieve higher-than- average patient and graft survival rates in recipients of combined pancreas and kidney transplants. Results of 92 cases are being presented by Robert Corry, M.D., professor of surgery at the Thomas E. Starzl Transplantation Institute May 16 at the ASTS scientific meeting. In order to control rejection, many surgeons customarily prescribe kidney/pancreas recipients a drug cocktail of anti-rejection drugs plus a 10- 14-day preparation of a potent serum that wipes out white blood cells in the immune system. The UPMC team did not use the serum, known as anti-lymphocyte induction therapy, and instead relied on tacrolimus, or Prograf, as its main line of defense against rejection. Survival among the 92 patients who underwent combined kidney and pancreas transplants at the UPMC since July 1994 was 98 percent; graft survival of the kidney and pancreas was 94 and 85 percent, respectively. According to the International Pancreas Transplant Registry, 1994-95 one-year patient survival rates are 91 percent in recipients of kidney/pancreas transplants and pancreas graft survival is 80 percent. Dr. Corry says graft survival at the UPMC has improved in part due to a novel surgical technique developed at the UPMC that protects the pancreas from injury as it is being removed from the donor and during its transport to the transplant center. Surgeons remove the pancreas, which is among the most frail of organs, as a parcel with the liver; the kidneys are removed in a separate surgical procedure. After the organs are transported to the transplant center hospital, the pancreas and liver are carefully dissected from each other. Typically, the liver is transplanted in one patient, and the pancreas, with or without one of the kidneys, is transplanted in another patient. CONTACT: Lisa Rossi, 412-647-3555. SOURCE University of Pittsburgh Medical Center