01 février 2008

Kidney transplants without maintenance immunosuppression

A new kidney transplant regimen- allowed 4 out of 5 patients receiving organs from mismatched donor relatives, to discontinue immunosuppression treatment, according to a study published in the New England Journal of Medicine. Until recently, unless a recipient received an organ transplant from an identical twin, lifetime maintenance immunosuppression has been necessary.

One patient rejected the kidney transplant on day 10 and required a second transplant several months later. This gentleman continues to require immunosuppression therapy. Chronic rejection and adverse effects associated with immunosuppressants continue to be problematic for organ transplant recipients. Immunosuppressants used after organ transplants include azathoiprine (Imuran), mycophenolate (Cellcept), sirolimus (Rapamune), tacrolimus (Prograf and Protopic), and cyclosporine (Neoral). Adverse events associated with these medications experienced by 10 to 35% of patients include pain (abdominal, chest, back), fever, headache, sepsis, weakness, hypertension, diarrhea, constipation, nausea, vomiting, dyspepsia, thrush, anemia, leucopenia, thrombocytopenia, shortness of breath, edema, acne, hypercholesterolemia and increased risk of infections (thrush, herpes and candida).

Patients in a new study received a combined bone marrow and kidney transplant. Beginning 5 days prior to surgery, organ recipients underwent a nonmyleoblative preparation regimen to develop tolerance. This is a ‘mini-transplant’ and involves a stem cell transplant from the donor, as well as chemotherapy and radiation to prepare the patient for the transplant. Out of a total of 5 patients, 4 were able to stop immunosuppressant treatment 9-14 months after surgery. Renal function for the 4 patients continues to remain stable 1.2-4.6 years post withdrawal from all immunosuppressants, with no evidence of rejection.

Tiré de Pharmacy Gateway

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