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New protocols in kidney- pancreas transplantation produces better results for patients


Patients now living insulin free and off dialysis

Due to refined surgical techniques and advances in anti-rejection therapy, transplant surgeons at the University of Pittsburgh’s Thomas E. Starzl Transplantation Institute (STI) are able to successfully perform a higher volume of kidney-pancreas transplants – more than 22 kidney-pancreas transplants in the past three months – which yields a shorter wait time on the transplant list, a better graft survival and quicker recovery. "People need to be more aware of our services, in particular, diabetic patients with end-stage renal disease," said Ngoc Thai, M.D., Ph.D., assistant professor of surgery and director of pancreas transplantation at STI.

Another advance in the field of kidney-pancreas transplantation is the use of the drug campath – a powerful immunosuppressant that depletes T and B cells – the cells that may cause rejection of the new organ. Only one dose is given before the transplant surgery. Because of its potency, a single dose of campath can be given to treat active rejection as well. There is little risk above and beyond the usual side-effects of immunosuppression. The advantage is that patients only need to take the anti-rejection medication FK after surgery, as opposed to a combination of FK, MMF and steroids. Currently, researchers at STI are one of a few transplant centers in the United States participating in a clinical trial to study the advantages of campath therapy for kidney-pancreas transplant recipients.

The pancreas is a five-inch organ that is located behind the stomach. One function of the pancreas is to produce enzymes that aid in the digestion of food. It also produces insulin, which is essential for life because it regulates the use of blood sugar throughout the body. In patients with diabetes, the pancreas stops producing insulin and the organ may shut down, eventually requiring a transplant. This stress also can affect the kidneys, so often a patient in need of a pancreas often will need a new kidney as well.

The three procedures used in these patients include a kidney from either a living or cadaveric donor and eventually a cadaveric pancreas at a later date; a simultaneous kidney-pancreas transplant; or a pancreas transplant alone. According to the United Network for Organ Sharing (UNOS) there are currently 2,420 people in the United States waiting for a kidney-pancreas transplant and 1,645 people waiting for a pancreas transplant alone. Currently at UPMC, there are roughly 20 people waiting for a combined kidney-pancreas transplant and approximately 20 people waiting for a pancreas transplant alone.

UPMC transplant programs comprise the world’s largest and busiest, where surgeons perform more types of organ transplants than at any other institution. On average, a transplant is performed every 12 hours at UPMC Montefiore or Children’s Hospital of Pittsburgh. Since 1981, more than 12,000 transplants have been performed, a single-center experience that is unmatched by any other program in the world. These transplants include liver, kidney, pancreas, small bowel, liver/small bowel, heart, heart/lung, double-lung, single-lung and multiple-organ transplants.

Pittsburgh’s transplant programs are internationally renowned for having had far-reaching influence on the entire field. UPMC researchers and surgeons have made many of transplantation’s most important advances. In recent years, clinical and research programs have involved novel approaches to induce tolerance of transplanted organs, and pioneering efforts to explore alternative sources of human organs, such as organs from animal donors or artificial organs.

Maureen McGaffin | EurekAlert!
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