Initial Results of Solitary Pancreas Transplants Performed Without Regard to Donor/Recipient Hla Mismatching

Gruber, Scott A.; Katz, Stephen M.; Kaplan, Bruce; Clark, James H.; Chen, Phebe C.; El-Sabrout, Rafik; Kerman, Ronald H.

doi:10.1097/00007890-200007270-00028

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…Although there are no obvious immunologic explanations, this may partially reflect changing clinical practice, with more aggressive protocols of pancreas transplant biopsy in the later era of the study (13). For example, at UMHS, percutaneous ultrasound guided pancreas biopsy has only recently become the prevalent method; previously, all pancreas transplant biopsies were done operatively.…”

Section: Discussionmentioning

confidence: 99%

Early Pancreas Transplant Outcomes with Histidine-Tryptophan-Ketoglutarate Preservation: A Multicenter Study

et al. 2006

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Little is known about the use of histidine-tryptophan-ketoglutarate (HTK) preservation solution for pancreas preservation. We compared early pancreas graft outcomes at four pancreas transplant programs within the state of Michigan in 2002 and 2003 (University of Wisconsin [UW] era) with those in 2004 (HTK era). The primary endpoint was early graft loss. The UW group (n=41) and the HTK group (n=36) had similar outcomes with respect to: technical graft loss (9.8% vs. 8.3%, P=NS), 90-day graft function (90.2% vs. 86.1%, P=NS), and rate of pancreatic leak/abscess (12.2% vs. 11.1%, P=NS). There were also no significant differences in postoperative amylase and lipase levels between the two groups. The HTK group did have significantly more acute rejection within the first 180 days (25.0% vs. 9.8%, P<0.05). HTK is a suitable substitute for UW in the preservation of pancreas allografts.

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Section: Discussionmentioning

confidence: 99%

Early Pancreas Transplant Outcomes with Histidine-Tryptophan-Ketoglutarate Preservation: A Multicenter Study

et al. 2006

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“…The results are excellent, regardless of the level of HLA system agreement 9 . When only pancreas is transplanted, in spite of the relatively small number of eligible patients, acceptable results are obtained even for low levels of HLA compatibility 10 . Regarding liver transplants, no effect of HLA system compatibility was found on longer patient survival, though there have been reports of a lower rate of acute rejections in patients with higher levels of HLA compatibility 11,12 .…”

Section: Discussionmentioning

confidence: 99%

HLA compatibility index: does it have a role in patients after heart transplantation?

Bedáňová

Orban²,

Ondrášek³

et al. 2013

BIOMED PAP

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Aims.To determine the impact of HLA compatibility measured by the Compatibility Index, on survival, rate of rejections, malignancies and infections in patients after heart transplantation (HTx). Methods. We carried out a retrospective analysis of 182 consecutive patients who underwent heart transplantation in our center from January 2001 to April 2010. According to degree of HLA-A, B and DR matching (Compatibility Index, CI) the patients were divided in two groups, Group A (n=83) with an IC 0-17 and group B (n=99) with an IC 18-26. There was no significant difference in demographic parameters between recipients and donors. Results. We found no difference in rates of rejections or infections between Group A and Group B (AR: 22 (26.5%) vs. 34 (34.3%), P=0.2539; infections: 21 (25.3%) vs. 27 (27%) P=0.7637). The distribution of infections in terms of type (bacterial, viral, fungal, including Aspergillus) was similar in both groups. The incidence of malignant tumours was infrequent (3 (3.6%) vs. 4 (4.0%), P=0.8817). We found trend toward lower level of tacrolimus in Group A. Long term survival was similar in both groups. Conclusions. Based on the results of our single-center trial, we found no impact of higher degree of HLA-A,-B, and -DR matching on survival, rejection episodes or infection. Further large studies are necessary to confirm our hypothesis that subjects with better HLA compatibility could require lower dose immunosuppression.

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“…In 2000, Gruber et al [8] reported a pancreas graft survival rate of 79% and a 50% incidence of acute rejection in 14 solitary PTX (seven PAKT, seven PA) recipients managed with OKT3 induction, TAC and MMF-based therapy, and without regard to donorirecipient HLA-matching. The majority of these transplantations were performed with bladder drainage.…”

Section: Discussionmentioning

confidence: 99%

Improving results in solitary pancreas transplantation with portal-enteric drainage, thymoglobin induction, and tacrolimus/mycophenolate mofetil-based immunosuppression

Stratta

Shokouh-Amiri

et al. 2003

Transplant Int

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Advances in surgical techniques and clinical immunosuppression have led to steadily improving results in pancreas transplantation (PTX). The purpose of this study was to analyze retrospectively the outcomes in patients undergoing solitary PTX with portal-enteric (P-E) drainage and contemporary immunosuppression. From June 1998 through December 2000, we performed 28 solitary PTXs with antibody induction and tacrolimus/mycophenolate mofetil maintenance therapy. The first 13 patients received daclizumab (DAC) induction, while the next 15 received thymoglobulin (rabbit anti-human thymocyte gamma globulin; Thymo) induction. The study group included 13 pancreas alone (PA) and 15 sequential pancreas-after-kidneytransplantations (PAKT). Solitary PTX was performed with P-E drainage in 18 patients and systemicenteric (S-E) drainage in ten. Patient and pancreas graft survival rates were 96% and 79%, respectively, with a mean follow-up of 22 (range 1-39) months. The 1-year actual death-censored pancreas graft survival rate was 89%. One PAKT patient died with a functioning graft at 1 month; three patients (1 1 YO) experienced early graft loss due to thrombosis and were excluded from the immunological analysis, leaving 24 evaluable patients. The incidence of acute rejection was 54%, including 50% in PA and 58% in PAKT recipients (P= NS). In patients receiving Thymo induction, the rate of acute rejection was slightly lower (43% Thymo vs 70% DAC). Moreover, P-E drainage was associated with a slightly lower rate of acute rejection (44% P-E vs 75% S-E; P = N S ) . In patients with both Thymo induction and P-E drainage (n = 1 1), there was a tendency toward less rejection (the incidence of acute rejection was 36%). Two immunological graft losses occurred (one due to non-compliance), both in patients with P-E drainage. Only one patient had a cytomegalovirus (CMV) infection. Event-free survival (no rejection, graft loss, or death) was slightly higher in patients receiving Thymo (47%) than in those on DAC (23%) induction ( P = NS). We can conclude that solitary PTX with P-E drainage and Thymo induction may be associated with improved intermediate-term outcomes and a possible immunological advantage.

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Initial Results of Solitary Pancreas Transplants Performed Without Regard to Donor/Recipient Hla Mismatching

Abstract: 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.

Cited by 16 publications

References 6 publications

Early Pancreas Transplant Outcomes with Histidine-Tryptophan-Ketoglutarate Preservation: A Multicenter Study

Early Pancreas Transplant Outcomes with Histidine-Tryptophan-Ketoglutarate Preservation: A Multicenter Study

HLA compatibility index: does it have a role in patients after heart transplantation?

Improving results in solitary pancreas transplantation with portal-enteric drainage, thymoglobin induction, and tacrolimus/mycophenolate mofetil-based immunosuppression

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