Pancreatic transplantation at the University of Pittsburgh.
Campath-1H preconditioning with tacrolimus monotherapy is an effective immunosuppressive regimen for pancreas transplantation, with acceptable patient and graft survival rates early after transplantation. Rejection rates are low under this protocol if the tacrolimus level is kept consistently >10 ng/ml. This immunosuppressive protocol, combined with recent technical refinements, has resulted in lower rates of thrombosis and overall complications. Pancreatic transplantation en-bloc with visceral grafts has the following unique features: Diabetes is a rare indication, and HLA matching is not required. The gland is immunologically protected by the simultaneously transplanted visceral organs. Disease gravity, surgical complexity and gut alloimmunity influence the overall pancreatic allograft survival. The current UNOS listing criteria and data registry should be modified for obvious logistic and scientific reasons.
Thai
Ngoc L
NL
The Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abu-Elmagd
Kareem
K
Khan
Akhar
A
Bond
Geoffrey
G
Basu
Amit
A
Tom
Kusum
K
Mazariegos
George
G
Sindhi
Rakesh
R
Reyes
Jorge
J
Tan
Henkie P
HP
Marcos
Amadeo
A
Starzl
Thomas E
TE
Shapiro
Ron
R
D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D010179:Pancreas / Q000033:anatomy & histology / Q000601:surgery; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000276:immunology / Q000379:methods* / Q000401:mortality; D010414:Pennsylvania / Q000453:epidemiology; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D019172:Transplantation Conditioning
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D016559:Tacrolimus