A Pilot Study of Immunosuppression Minimization After Pancreas-Kidney Transplantation Utilizing Thymoglobulin Induction and Sirolimus Maintenance Therapy

Knight, Richard J.; Kerman, Ronald H.; McKissick, Eva; Lawless, Amy; Podder, Hemangshu; Katz, Stephen M.; Buren, Charles T. Van; Kahan, Barry D.

doi:10.1016/j.transproceed.2005.09.087

Cited by 14 publications

(8 citation statements)

References 8 publications

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“…3 Since its approval, the Cylex assay has been used to tailor immunosuppression in transplant recipients of kidney, pancreas, small intestine, liver and heart. 1,8,9 However, the clinical data in cardiac transplant recipients are limited. 3 In this single-center study of 111 stable cardiac transplant recipients, the Cylex assay had limited utility in predicting risk of infection or rejection when used as an adjunct to routine clinical evaluation and drug-level monitoring.…”

Section: Discussionmentioning

confidence: 99%

Utility of the Cylex Assay in Cardiac Transplant Recipients

Gupta

Mitchell

Markham

et al. 2008

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

Utility of the Cylex Assay in Cardiac Transplant Recipients

Gupta

Mitchell

Markham

et al. 2008

The Journal of Heart and Lung Transplantation

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“…Cleared by the Food and Drug Administration in April 2002, the Cylex ImmuKnow assay has been shown to be capable of measuring global immune response, especially T cell–mediated immunity, in transplant patients 20–27. This assay measures the CD4 T‐lymphocyte response to phytohemagglutinin by quantifying the amount of adenosine triphosphate (ATP) produced by the cells following stimulation 20.…”

mentioning

confidence: 99%

Using an immune functional assay to differentiate acute cellular rejection from recurrent hepatitis C in liver transplant patients

et al. 2009

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In transplant recipients transplanted for hepatitis C, presentation of abnormal transaminases can herald the presentation of recurrent hepatitis C, cellular rejection, or both. Given the sometimes ambiguous histology with these 2 entities, the ability to distinguish them is of great importance because misinterpretation can potentially affect graft survival. We used an immune functional assay to help assess the etiology of abnormal liver function test results in liver transplant recipients. Blood samples for the immune functional assay were taken from 42 recipients prospectively at various times post-transplant and compared with clinical and histologic findings. In patients whose liver biopsy showed evidence of cellular rejection, the immune response was noted to be very high, whereas in those with active recurrence of hepatitis C, the immune response was found to be very low. This finding was found to be statistically significant (P Ͻ 0.0001). In those patients in whom there was no predominant histologic features suggesting 1 entity over the other, the immune response was higher than in those with aggressive hepatitis C but lower than in those with cellular rejection. In conclusion, these data show the potential utility of the ImmuKnow assay as a means of distinguishing hepatitis C from cellular rejection and its potential usefulness as a marker for outlining the progression of hepatitis C. Liver Transpl 15:216-222, 2009.

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“…Knight et al. [24] reported 125 pancreas recipients in whom CyA was converted to MMF at 6 months post‐transplant using SRL‐based regimen. There were no rejections or losses at 9‐month follow‐up.…”

Section: Calcineurin Inhibitors Avoidance/withdrawal In Corticosteroimentioning

confidence: 99%

Minimization protocols in pancreas transplantation

Cantarovich

Vistoli

2009

Transplant International

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Diagnosis of immunologic injury (acute and chronic) is much more difficult in pancreas transplants when compared with transplants of other organs. Currently, the immunosuppressive regimen for induction involves calcineurin inhibitors (CNI), antimetabolites and corticosteroids (Cs). This strong and nonspecific regimen does not take into consideration pancreas specificities (i.e. the need to avoid diabetogenic compounds). For obvious reasons, CNI might be calling for review, if permanently indicated in recipients of solitary pancreas with mild renal dysfunction. CNI as well as corticosteroids may induce hyperglycemia and contribute to differential diagnosis of a rejection process. However, in spite of the benefits accruing from withdrawal of above immunosuppressive agents, minimization or avoidance of these drugs could be dangerous and may end up with graft loss (i.e. antibody-mediated process). Long-term results of pancreas transplantation are now achieving comparable survival rates similar to the transplant of traditional organs such as kidney and liver. As a consequence, the physicians’ objectives are to prolong the patient’s quality of life and organ function as long as possible. Weaning strategies in regard to CNI and steroids are tested. Sirolimus, everolimus, CTLA-4 Ig, etc, are agents known to be either both nonnephrotoxic and nondiabetogenic or less so when compared with CNI. Their impact on pancreas transplantation is beginning to be evaluated. Large randomized trials in all pancreas categories, with long-term clinical and histologic results, are mandatory to establish new guidelines for immunosuppressive regimens for pancreas transplantation

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A Pilot Study of Immunosuppression Minimization After Pancreas-Kidney Transplantation Utilizing Thymoglobulin Induction and Sirolimus Maintenance Therapy

Cited by 14 publications

References 8 publications

Utility of the Cylex Assay in Cardiac Transplant Recipients

Utility of the Cylex Assay in Cardiac Transplant Recipients

Using an immune functional assay to differentiate acute cellular rejection from recurrent hepatitis C in liver transplant patients

Minimization protocols in pancreas transplantation

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