Transplant patients from 40 years ago cause Pittsburgh doctors to take an about-face

MIAMI, Aug. 26 In a radical departure from the standard way of treating transplant patients, doctors from the University of Pittsburgh's Thomas E. Starzl Transplantation Institute have gone back to the future, so to speak.

Instead of the current practice of giving patients high doses of multiple drugs to suppress the immune system as soon as the organ is transplanted, the Pittsburgh team is giving a one-time dose of a drug that depletes important immune system cells just hours before transplantation and lower-than- usual doses of just one anti-rejection drug beginning the day after transplantation. Ninety days later, if there has been no rejection, the weaning process begins.

A similar strategy, without the deliberate attempt to wean, was in place 40 years ago. Seven of nine recipients of living-donor kidney transplants from that era have been off all anti-rejection drugs for between two and one-half and 38 years. Some stopped taking the drugs on their own. Others were weaned under doctors' supervision. That clinical experience of four decades ago coupled with a modern understanding of what is required for the immune system to accept a transplanted organ without the need for immunosuppression, led to the "new" clinical approach, said Thomas E. Starzl, M.D., Ph.D., at the XIX International Congress of The Transplantation Society.

Since implementing the regimen, which aims to radically reduce and eventually wean patients off all immunosuppression, some transplant recipients of the small bowel, an organ especially prone to rejection, are taking a single anti-rejection drug and only once or twice a week, University of Pittsburgh researchers reported today. Many kidney, liver and pancreas transplant patients being treated under the new philosophy, introduced last year, are on minimal weekly doses as well.

In order to prevent rejection of the transplanted organ, doctors typically provide patients with strong immunosuppressives, often in

Contact: Lisa Rossi
University of Pittsburgh Medical Center

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