Pancreas transplantation immunosuppression

Alemtuzumab (campath-lH) is a humanized monoclonal antibody specific for the CDw52 antigen, present on cell membranes of lymphocytes and monocytes. It has been used for treatment of patients with rheumatoid arthritis and vasculitis, is being investigated for the treatment of chronic lymphocytic leukemia, and has been used to deplete circulating lymphocytes in patients with multiple sclerosis (1). In 2001, alemtuzumab was approved in Europe for the treatment of chronic B cell lymphocytic leukemia that had been treated previously with alkylating agents and was refractory to fludarabine (2). It has also been used for induction of immunosuppression/tolerance in liver transplant recipients (3,4) and kidney/pancreas transplant recipients (5). 

Islet cell and whole pancreas transplantation are occasionally used in patients, nsually renal transplants, who reqnire immunosnp-pressive therapy for other reasons. There has been considerable interest in islet cell transplantation since investigators in Edmonton reported snccess without using glucocorticoids as immunosuppressive agents. Some of these patients are able to come off insnlin altogether. 

Pancreas transplantation, with immunosuppression therapy, has become clinically acceptable (10) at least for those who also receive kidney transplants (despite the nephrotoxicity of cyclosporin). Islet transplants are simpler sur-... 

Muthusamy ASR, Vaidya AC, Sinha S, Roy D, Elker DE, Friend PJ. Alemtuzumab induction and steroid-free maintenance immunosuppression in pancreas transplantation. Am J Transplant 2008 8 2126-31. 

Clinical Use. Cyclosporine (Neoral, Sandimmune) is one of the primary medications used to suppress immune function following organ transplantation.14 21 69 This medication can be used alone or combined with glucocorticoids, azathioprine, and other immunosuppressants to prevent the rejection of a kidney, lung, liver, heart, pancreas, and other organ transplants. 

Cyclosporin A, a fungal metabolite, is a cyclic polypeptide that consists of 11 amino acids. It has a biologic half-life of 4 to 6 h and displays a preferential T cell cytotoxic property, in that it inhibits the factors that stimulate T lymphocyte proliferation. Cyclosporin A has been used as the sole immunosuppressant (without prednisone or other drugs) for cadaveric transplants of the kidney, pancreas, and liver. Cyclosporin A has been observed to cause reversible hepatic toxicity and nephrotoxicity. 

The development of organ transplants—which include kidneys, Mver, heart, lungs, and pancreas— has led to the development of immunosuppressant drugs. These drugs are meant to suppress the body s natural reaction to reject the for-... 

After these initial approaches in animal models, ECP has been used in humans for the prevention and/or treatment of several solid organ transplant rejections, including kidney, heart, lung, pancreas, and liver. The year of introduction of ECP for treating rejection of each type of transplant is indicated in Table 5. Importantly, ECP is effective for patients resistant to conventional treatment, particularly if started early. Besides reversal of allograft rejection, a reduction in immunosuppressive therapy has also been frequently achieved [173,174]. 

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