Treatment pancreas transplantation

The drugs like azathioprine and cyclosporine A are used chiefly to prevent transplant rejection and in the treatment of autoimmune diseases. They are used to prevent graft rejection after kidney, liver, lung, pancreas transplant or bone marrow transplantation. 

Valganciclovir is indicated for the treatment of CMV retinitis in patients with AIDS and for the prevention of CMV disease in high-risk kidney, heart, and kidney-pancreas transplant patients. Adverse effects, drug interactions, and resistance patterns are the same as those associated with ganciclovir. 

A scientific registry of transplant recipients has been used to determine the effect of cadaveric organ donor treatment with desmopressin on the incidence of pancreas graft thrombosis in clinical pancreas transplantation (70). Of 2804 cases with sufficient information between 5 April 1994 and 27 September 2002, 1287 (46%) had received desmopressin. The mean follow up was 1.5 years (1 month to 8.4 years). There was pancreatic graft thrombosis in 4.3%, of whom 5.1% had received desmopressin and 3.5% had not this was just statistically significant. There was no information about dose, time-course, or duration of desmopressin use. It is not known whether this finding is clinically significant. 

Malaise J, Leonet J, Goffin E, Lefebvre C, Tennstedt D, Vandeleene B, Buysschaert M, Squifflet J. Pancreas transplantation for treatment of generalised allergy to human insulin in type I diabetes. Transplant Proc 2005 37 2839. 

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). 

Rosenberg L, Dafoe DC, Schwartz R, Campbell DA, Turcotte JG, Tsai S-T, Vinik A Administration of somatostatin analog (SMS 201-995) in the treatment of a fistula occurring after pancreas transplantation, Interference with cyclosporine suppression. Transplantation (1987) 43, 764-6. 

Unlabeled Uses Prevention of organ rejection in patients receiving allogeneic bone marrow, heart, pancreas, pancreatic island cell, or small-bowel transplant, treatment of autoimmune disease, severe recalcitrant psoriasis... 

Marques RG, Rogers J, Chavin KD, Baliga PK, Lin A, Emovon O, Afzal F, Baillie GM, Taber DJ, Ashcraft EE, Rajagopalan PR. Does treatment of cadaveric organ donors with desmopressin increase the likelihood of pancreas graft thrombosis Results of a preliminary study. Transplant Proc 2004 36 1048-9. 

Antithymocyte globulin — Treatment of rejection of kidney, heart, liver, lung, pancreas, and bone marrow transplants... 

There are various clinical conditions where administration of cultured whole cells or tissue may be desirable. The sources of these tissues are as diverse as the disease targets. For example, cultured fibroblasts from human prepuces are being developed as artificial skin for the treatment of leg ulcers and bums (Advanced Tissue Sciences, La Jolla, California Smith and Nephew, Romford, UK). Other companies are developing implantable pancreas generated from isolated pancreatic islet cells. Unlike matched transplantations, such therapies may involve treatment of large numbers of patients from a limited or sole initial human source or may be autologous albeit after some ex vivo manipulation and culturing of the cell mass before reimplantation. 

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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