University of Pittsburgh approach has lung recipients taking far f...( ransplant patients in whom studies tha...),Health

ransplant patients, in whom studies that seek to reduce anti-rejection drugs are rarely performed out of fear that the lungs, already the most vulnerable organ to rejection, would succumb to an irreversible immune system attack, placing patients at risk for death. Ironically, lung recipients have the greatest incidence of immunosuppression-related complications, such as infection and chronic kidney dysfunction, providing incentive to search for alternative immunosuppression approaches.

UPMC's clinical protocol involves a one-time dose of a drug that depletes T cells key immune system cells that are known to target the donor organ that is given just before transplantation. Following transplantation, patients are treated with just one anti-rejection drug, tacrolimus, that is administered at reduced levels. Since many lung recipients are treated with prednisone for their underlying disease, the steroid is continued after transplant but at a negligible dose, 5 mg compared to 20 mg.

The rationale is to treat patients with as little immunosuppressive medication as possible following the transplant while preventing injury to the graft by the recipient's immune system.

Since June of 2002, more than 80 patients have been treated under the protocol. At ATC, Dr. McCurry reported results in many of these patients, including 31 who have been followed for more than a year after transplant, several for nearly two years.

The first 38 patients were given a pre-transplant drug called Thymoglobulin. One-year survival for these patients is 87 percent. The remaining patients received Campath, which appears to deplete T cells more broadly and for a longer period of time. Acute rejection episodes have been less in the Campath patients reported on at ATC compared to those who received Thymoglobulin. Twenty-five of the 38 Thymoglobulin patients had rejection episodes greater or equal to Grade 2, compared to two of the first10 Campath treated patients.
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16-May-2004

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