Abandoning a standard drug treatment strategy used at most other transplant programs, surgeons at the UPMC were able to achieve higher-than-average patient and graft survival rates in recipients of combined pancreas and kidney transplants. Results of 92 cases are being presented by Robert Corry, M.D., professor of surgery at the Thomas E. Starzl Transplantation Institute May 16 at the ASTS scientific meeting.
In order to control rejection, many surgeons customarily prescribe kidney/pancreas recipients a drug cocktail of anti-rejection drugs plus a 10-14-day preparation of a potent serum that wipes out white blood cells in the immune system. The UPMC team did not use the serum, known as anti-lymphocyte induction therapy, and instead relied on tacrolimus, or Prograf, as its main line of defense against rejection.
Survival among the 92 patients who underwent combined kidney and pancreas transplants at the UPMC since July 1994 was 98 percent; graft survival of the kidney and pancreas was 94 and 85 percent, respectively. According to the International Pancreas Transplant Registry, 1994-95 one-year patient survival rates are 91 percent in recipients of kidney/pancreas transplants and pancreas graft survival is 80 percent.
Dr. Corry says graft survival at the UPMC has improved in part due to a novel surgical technique developed at the UPMC that protects the pancreas from injury as it is being removed from the donor and during its transport to the transplant center. Surgeons remove the pancreas, which is among the most frail of organs, as a parcel with the liver; the kidneys are removed in a separate surgical procedure. After the organs are transported to the transplant center hospital, the pancreas and liver are carefully dissected from each other. Typically, the liver is transplanted in one patient, and the pancreas, with or without one of the kidneys, is transplanted in another patient.