Pittsburgh Reports on Effort to Wean Patients From Immunosuppressive Drugs

For more than a year, the University of Pittsburgh has been pursuing an against-the-grain approach to treating transplant patients aimed at ultimately weaning them from lifelong daily dependence on a combination of immunosuppressive medications.

At sessions this week of the 19th International Congress of The Transplantation Society, Pittsburgh researchers reported surprising success in enabling kidney, kidney-pancreas, liver and intestinal transplant patients to cutback to only one anti-rejection drug taken in some cases only once or twice a week.

"What we're looking at here is a drastic rethinking of immunosuppression," said Dr. Thomas E. Starzl.

Unlike virtually all other transplant programs that start recipients on high doses of immunosuppressive drugs, the Pittsburgh approach relies on pretreatment with a large dose of thymoglobulin to deplete immune cells in the hours preceding transplantation, followed by twice-daily treatment with just Prograf starting the day after transplantation.

Researchers reported at the conference on their experience using this approach on 250 patients transplanted between July 2001 and November 2001.

Reporting on 50 kidney patients, including 10 kidney-pancreas patients, Starzl said that doctors after several months started what he called "spaced weaning" by first reducing their doses of Prograf to once a day.

Now, anywhere from 10 to 14 months after their transplants, Starzl said that 4 of these patients are taking Prograf only once a week,15 are taking the drug twice a week, 6 are taking it three times a week, and 10 are taking it every other day.

And of the 50 kidney patients, he reported a 98 percent patient survival rate (one died of an anesthesia accident) and a 94 percent survival rate for the transplanted kidney. Similarly encouraging results were presented at the meeting for liver and intestinal transplant patients.

"The explanation for these striking results does not lie in the details of the weaning, but in the way that immunosuppression was used for pretreatment and in the early weeks after transplantation," Starzl said.

The least possible use of immunosuppression consistent with organ survival in the early days following transplantation, he argued, is the key to the body's acquiring a tolerance to the transplanted organ, and to the ability to ultimately taper off immunosuppression

"Our results ... suggest that a quantum improvement in organ transplantation is within easy grasp," he said.

Other sources: 19th International Congress of The Transplantation Society