PMID- 12717220
OWN - NLM
STAT- MEDLINE
DCOM- 20030515
LR  - 20131121
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 75
IP  - 8
DP  - 2003 Apr 27
TI  - Thymoglobulin, sirolimus, and reduced-dose cyclosporine provides excellent 
      rejection prophylaxis for pancreas transplantation.
PG  - 1301-6
AB  - BACKGROUND: We investigated a novel immunosuppressive protocol including 
      thymoglobulin induction in combination with sirolimus and corticosteroids, 
      followed by introduction of markedly reduced exposures to cyclosporine to prevent 
      pancreas-transplant rejection. METHODS: A 7-day course of thymoglobulin (1.5 
      mg/kg per day) was begun on postoperative day (POD) 0, together with 15 mg of 
      sirolimus on POD 1, and followed by 5 mg per day, targeting these doses to 
      achieve a trough of 10 to 20 ng/mL. When the serum creatinine was below 2.5 
      mg/dL, cyclosporine was introduced at 50 mg twice daily with dose adjustment to 
      maintain a trough concentration of 100 to 125 ng/mL. RESULTS: The 18 patients 
      included 14 simultaneous pancreas-kidney and 4 pancreas-after-kidney transplant 
      recipients. Two patients were African-American, three patients had a 
      pretransplant panel reactive antibody greater than 20%, and the human leukocyte 
      antigen (HLA) mismatch was 4.5+/-1 (mean+/-standard deviation). With a mean 
      follow-up of 13.6+/-4.7 months, patient, kidney, and pancreas graft survivals are 
      100%, 100%, and 94%, respectively. A single pancreas graft was lost to 
      thrombosis. There were no acute rejection episodes and no opportunistic 
      infections. Mean hospital stay was 9+/-3 days. At 3 months posttransplantation, 
      the mean value of serum creatinine was 1.2+/-0.3 mg/dL, fasting glucose was 
      88+/-15 mg/dL, and sirolimus dose at month 3 was 6.3+/-3 mg per day and at month 
      12 2.7+/-1 mg per day. The average total daily cyclosporine A dose at month 3 was 
      208+/-62 mg per day and 133+/-13 mg per day at 1 year. CONCLUSIONS: This 
      immunosuppressive regimen provided excellent prophylaxis against acute rejection 
      with no opportunistic infections. We believe that careful monitoring of sirolimus 
      and cyclosporine levels was critical to success of this protocol.
FAU - Knight, Richard J
AU  - Knight RJ
AD  - Division of Immunology and Organ Transplantation, The University of Texas Health 
      Science Center at Houston, Texas 77030, USA.
FAU - Kerman, Ronald H
AU  - Kerman RH
FAU - Zela, Scott
AU  - Zela S
FAU - Podder, Hemangshu
AU  - Podder H
FAU - Van Buren, Charles T
AU  - Van Buren CT
FAU - Katz, Stephen
AU  - Katz S
FAU - Kahan, Barry D
AU  - Kahan BD
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Lipids)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Adult
MH  - Antilymphocyte Serum/*therapeutic use
MH  - Cyclosporine/*administration & dosage
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Graft Rejection/*prevention & control
MH  - Graft Survival
MH  - Hernia/etiology
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage/*therapeutic use
MH  - Kidney/physiopathology
MH  - Lipids/blood
MH  - Male
MH  - Middle Aged
MH  - Pancreas/physiopathology
MH  - *Pancreas Transplantation/adverse effects
MH  - Prospective Studies
MH  - Sirolimus/*therapeutic use
MH  - Surgical Wound Infection/etiology
MH  - T-Lymphocytes/*immunology
EDAT- 2003/04/30 05:00
MHDA- 2003/05/16 05:00
CRDT- 2003/04/30 05:00
PHST- 2003/04/30 05:00 [pubmed]
PHST- 2003/05/16 05:00 [medline]
PHST- 2003/04/30 05:00 [entrez]
AID - 10.1097/01.TP.0000061768.98058.EC [doi]
PST - ppublish
SO  - Transplantation. 2003 Apr 27;75(8):1301-6. doi: 
      10.1097/01.TP.0000061768.98058.EC.