Simultaneous Administration of Adjuvant Donor Bone Marrow in Pancreas Transplant Recipients
From the Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
- (1888PressRelease) September 20, 2010 - Robert J. Corry, MD, Pradip K. Chakrabarti, MD, Ron Shapiro, MD, Abdul Rao, MD, DPhil, Igor Dvorchik, PhD, Mark L. Jordan, MD, Velma P. Scantlebury, MD, Carlos A. Vivas, MD, John J. Fung, MD, PhD, and Thomas E. Starzl, MD, PhD.
Objective
The effect of donor bone marrow was evaluated for its potentially favorable effect in the authors' simultaneous pancreas/kidney transplant program.
Methods
From July 1994 to January 1999, 177 pancreas transplants were performed, 151 of which were simultaneous pancreas/kidney transplants. All patients received tacrolimus, mycophenolate mofetil, and steroids for immunosuppression (azathioprine was used in the first year of the program). Fifty-three simultaneous pancreas/kidney transplant recipients received perioperative unmodified donor bone marrow, 3 to 6 × 108 cells/kg.
Results
Overall actuarial survival rates at 1 and 3 years were 98% and 95% (patient), 95% and 87% (kidney), and 86% and 80% (pancreas), respectively. In the adjuvant bone marrow group, 1- and 3-year survival rates were 96% and 91% (patient), 95% and 87% (kidney), and 83% and 83% (pancreas), respectively. For 98 recipients who did not receive bone marrow, survival rates at 1 and 3 years were 100% and 98% (patient), 96% and 86% (kidney), and 87% and 79% (pancreas), respectively. No pancreas allografts were lost after 3 months in bone marrow recipients, and seven in the non-bone marrow recipients were lost to rejection at 0.7, 6.7, 8.8, 14.6, 24.1, 24.3, and 25.5 months.
Twenty-two percent of bone marrow patients were steroid-free at 1 year, 45% at 2 years, and 67% at 3 years. Nineteen percent of the non-bone marrow recipients were steroid-free at 1 year, 38% at 2 years, and 45% (p = 0.02) at 3 years. The mean acute cellular rejection rate was 0.94 ± 1.1 in the bone marrow group and 1.57 ± 1.3 (p = 0.003) in the non-bone marrow group (includes borderline rejection and multiple rejections). The level of donor cell chimerism in the peripheral blood of bone marrow patients was at least two logs higher than in controls.
Conclusion
In this series, which represents the largest experience with adjuvant bone marrow infusion in pancreas recipients, there was a higher steroid withdrawal rate (p = 0.02), fewer rejection episodes, and no pancreas graft loss after 3 months in bone marrow recipients compared with contemporaneous controls. All pancreas allografts lost to chronic rejection (n = 6) were in the non-bone marrow group. Donor bone marrow administered around the time of surgery may have a protective effect in pancreas transplantation.
About Dr. Abdul Rao
Dr. Abdul S. Rao did his medical degree from Dow Medical University, Karachi, Pakistan, in 1983. After completing his residency training in Orthopedic Surgery, Abdul Rao joined the Department of Physiology, Boston University School of Medicine and graduated in 1989 with a M.A., in Physiology. He completed a year of post-doctoral Research Fellowship in the Department of Neurology, Harvard Medical School. Dr. Abdul Rao joined the Nuffield Department of Surgery, University of Oxford, Oxford, UK, as a Clinical Instructor from 1990-1993. He graduated from the University of Oxford with a D.Phil., (Doctor of Philosophy) in Transplantation Immunology in 1993.
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