Ironically, in a report of these transplants, Dr. Starzl and his colleagues suggested in a 1963 landmark paper published in the journal Surgery, Gynecology & Obstetrics that in order to better prevent rejection and control rejection, it might be reasonable to give the prednisone along with the azathioprine as standard therapy. In what, in retrospect, was an error, this suggestion was acted upon after performing 45 cases. In addition, pre-treatment with the azathioprine also was soon abandoned as infectious complications prior to transplantation became a problem.
"These decisions have had a lasting influence on clinical practice. After making these changes, no similar cluster of drug-free kidney recipients was produced anywhere in the world for the last 40 years either. We have much better drugs today, and we have a more clear understanding about tolerance. As such, we have come to realize that the way we have been managing patients these last four decades has been self-defeating," stated Dr. Starzl.
Results involving 22 recipients of small intestine, liver-small bowel and multivisceral transplants presented today by Kareem Abu-Elmagd, M.D., professor of surgery at the University of Pittsburgh's Starzl Institute, were among the first in the University of Pittsburgh series to be discussed at the congress, which runs through Friday. Seventeen of these 22 patients also received donor bone marrow and intestinal grafts that had been irradiated prior to transplantation, which the researchers said had little bearing on outcome.
Twelve of the 22 patients, who had no rejection for up to 90 days, were selected for weaning off tacrolimus. The process was conducted in a step-wise fashion, with reductions in the number of doses made every two weeks. Nine of the 12 patients have been free of rejection since weaning was initiated, including a recipient of an isolated small bowel that had not been irradiated, who has been on a once-a-week dose
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Contact: Lisa Rossi
412-647-3555
University of Pittsburgh Medical Center
26-Aug-2002