Reduced dose Thymoglobulin<sup>®</sup>, tacrolimus, and mofetil mycophenolate results in excellent solitary pancreas transplantation outcomes

Tan, Michael J.; Cantarovich, Marcelo; Mangel, R; Paraskevas, Steven; Fortier, Michelle A.; Metrakos, Peter

doi:10.1034/j.1399-0012.2002.02031.x

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…However, primary enteric drainage historically has been associated with a higher incidence of early graft thrombosis, a complication that is already the major cause of graft loss in our PTA recipients (10). Although tacrolimus appears to have significantly decreased early acute rejection and prolonged intermediate graft survival of PTA, immunosuppressive strategies involving lower doses or even avoidance of tacrolimus might be equally effective immunologically and allow for minimizing the reliance on a known nephrotoxin (11). Recently, polyomavirus has been described arising from the native kidneys of two PTA recipients, and this could contribute to the rapid progression of renal dysfunction in patients who have adequate GFR at the time of transplantation (12).…”

Section: Correlation Between Measured and Calculated Renal Function Amentioning

confidence: 96%

Decline in native renal function early after bladder-drained pancreas transplantation alone

et al. 2004

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Section: Correlation Between Measured and Calculated Renal Function Amentioning

confidence: 96%

Decline in native renal function early after bladder-drained pancreas transplantation alone

et al. 2004

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“…A monitorização freqüente dos índices hematimétricos, da coagulação sangüínea, função hepática e renal, associadas à aplicação adequada de técnica cirúrgica, contribuíram para o sucesso terapêu-tico no transplante isolado de pâncreas nesse caso, com ajuste adequado das drogas (Tacrolimus e Microfenolato Mofetic) e boa evolução do paciente, o que vem sendo preconizado na literatura (18,20,21).…”

Section: Discussionunclassified

Transplante de pâncreas na síndrome de Mauriac: evolução clínica e laboratorial após um ano de acompanhamento

Maia

Araújo

2005

Arq Bras Endocrinol Metab

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RESUMOO transplante de pâncreas tem se mostrado método eficaz no tratamento do diabetes mellitus tipo 1 (DM1) em casos selecionados, com redução da necessidade diária de insulina e normalização da glico-hemoglobina (A1c). Não há conhecimento, ainda, sobre o efeito do transplante de pâncreas em pacientes com síndrome de Mauriac (SM). Apresentamos um caso de SM refratário ao tratamento clínico instituído (insulinoterapia intensiva, atividade física programada, acompanhamento psicológico e nutricional), com persistência de níveis de glicemia de jejum e A1c continuamente elevados, dislipidemia e IGF-1 (fator de crescimento insulina símile) reduzido, sendo indicado o transplante pancreático. Após 1 ano do transplante de pâncreas total, o paciente permanecia assintomático, insulino-independente, com glicemia de jejum adequada (<110mg/dl), normalização do perfil lipídico e de IGF-1, com redução importante da A1c (4,6%), melhora da auto-estima e maior qualidade de vida para o paciente. O transplante de pâncreas mostrou-se método eficaz no controle da SM, com reversão importante dos parâmetros clínico-laboratoriais nesse caso. Objetiva-se divulgar o primeiro caso de SM controlado com transplante de pâncreas descrito na literatura médica indexada, como alternativa terapêutica nesse grupo de pacientes. In select cases of type 1 diabetes mellitus (DM1) the pancreas transplantation has been shown to ameliorate the disease, to reduce the need for exogenous insulin and normalize glycosylated hemoglobin (A1c) levels. The efficacy of this therapy in Mauriac Syndrome (SM) is not yet well established. We report a patient with MS treated with intensive insulin therapy, physical activity program, nutritional and psychological assistance, with persistently elevated fast glycemia and A1c levels, inadequate lipid profile and decreased IGF-1 (insulin like growth factor) levels. Due to a poorly metabolic control, pancreas transplantation was indicated. After one year follow up, the patient had no symptoms and showed persistent insulin independence with fast glucose <110mg/dl, normal lipid profile and IGF-1 levels and significant decrease in A1c (4.6%). The pancreas transplantation improved diabetes control and promoted better quality of life for this patient. Pancreas transplantation proved to be an effective treatment strategy in patients with MS, improving their clinical and biochemical derangements. In this report we present the first case of MS controlled by pancreas transplantation registered in the indexed medical literature, as an alternative therapy in this group of patients.

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“…The efficacy of Thymoglobulin for the prevention of allograft rejection has been demonstrated in clinical studies (1)(2)(3)(4)(5)(6)(7)(8).…”

Section: Transplant Rejectionmentioning

confidence: 98%

Selected Mechanistic Studies and Future Directions for Thymoglobulin

Ruzek¹,

Dzuris²,

Gao³

et al. 2007

Transplantation

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A murine anti-thymocyte globulin, which was made in rabbits using the same manufacturing protocol used in production of Thymoglobulin (Genzyme Transplant, Cambridge, MA), was used to explore the biology and mechanism of action of Thymoglobulin. These preclinical studies suggest that determining optimal dosing and timing of Thymoglobulin can contribute to maximizing protection against allograft rejection. The murine anti-thymocyte globulin has a demonstrated ability to induce cells in vitro with a T-regulatory phenotype and was also shown to be effective in vivo in protecting mice against acute GVHD and in reversing overt diabetes in nonobese diabetic mice. The mechanistic rationale for Thymoglobulin as a therapeutic agent for the treatment of systemic lupus erythematosus, multiple myeloma, and myelodysplastic syndrome was also explored.

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Reduced dose Thymoglobulin^®, tacrolimus, and mofetil mycophenolate results in excellent solitary pancreas transplantation outcomes

Abstract: Monitoring the total leukocyte and lymphocyte count resulted in a 43% reduction in the amount of TMG used compared with the recommended dosing. Despite the reduced amounts, patient and graft survival were excellent with acute rejection rates comparing favorably to other published series.

Cited by 12 publications

References 15 publications

Decline in native renal function early after bladder-drained pancreas transplantation alone

Decline in native renal function early after bladder-drained pancreas transplantation alone

Transplante de pâncreas na síndrome de Mauriac: evolução clínica e laboratorial após um ano de acompanhamento

Selected Mechanistic Studies and Future Directions for Thymoglobulin

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Reduced dose Thymoglobulin®, tacrolimus, and mofetil mycophenolate results in excellent solitary pancreas transplantation outcomes

Abstract: Monitoring the total leukocyte and lymphocyte count resulted in a 43% reduction in the amount of TMG used compared with the recommended dosing. Despite the reduced amounts, patient and graft survival were excellent with acute rejection rates comparing favorably to other published series.

Cited by 12 publications

References 15 publications

Decline in native renal function early after bladder-drained pancreas transplantation alone

Decline in native renal function early after bladder-drained pancreas transplantation alone

Transplante de pâncreas na síndrome de Mauriac: evolução clínica e laboratorial após um ano de acompanhamento

Selected Mechanistic Studies and Future Directions for Thymoglobulin

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Product

Resources

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Reduced dose Thymoglobulin^®, tacrolimus, and mofetil mycophenolate results in excellent solitary pancreas transplantation outcomes