New Antirejection Regimen for Transplant Patients

A new clinical protocol for fighting rejection in transplant patients has shown that some patients have been able to reduce their medications to one pill a day.

The new approach is the only one of its kind involving lung transplant patients, in whom such studies are rarely performed because the lungs are the most vulnerable to rejection and the fear that reducing antirejection drugs might place patients at risk for death. The new protocol involves a drug that depletes T cells, which is given just before transplantation. After transplantation, patients are treated with just one antirejection drug, tacrolimus, which is administered at reduced levels. Prednisone is continued after transplant but in a negligible dose (5 mg instead of 20 mg).

The rationale is to treat patients with as little immunosuppressive medication as possible following the transplant while preventing injury to the graft by the recipient's immune system. Since June 2002, more than 80 patients have been treated under the new protocol. The results were reported at the American Transplant Congress (ATC) in Boston (MA, USA) in May 2004 by Kenneth R. McMurray, M.D., assistant professor of surgery at the University of Pittsburgh School of Medicine (PA, USA).

The first 38 patients were given a pretransplant drug called Thymoglobulin. One-year survival of these patients is 87%. The remaining patients received Campath, which appears to deplete T cells more broadly and for a longer period of time. Twenty-five of the 38 Thymoglobulin patients had rejection epidodes greater or equal to Grade 2, compared to two of the first 10 Campath-treated patients. There were no opportunistic infections or complications in the patients treated with Campath. The overall patient survival for Thymoglobulin-treated patients is 84% while in the Campath-treated group it is 98%.

"We are encouraged by these preliminary results. What remains to be seen is if our approach will have an impact on chronic rejection,” said Dr. McMurray.





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