University of Maryland Medical Center researchers have designed a strategy to improve the function of transplanted kidneys in some patients and, in a separate study, they used high PRA rescue to be able to provide kidney transplants to six patients who were on dialysis.
Results of both studies were presented in May at the annual scientific meetings of the American Society of Transplantation and the American Society of Transplant Surgeons.
The first study, presented by Matthew Weir, MD, at the AST meeting, focused on 60 patients who had undergone kidney transplantation an average of three years earlier and who had been diagnosed with chronic allograft nephropathy but had not had a recent acute rejection episode. In an attempt to stabilize kidney function, researchers cut the patients' dose of cyclosporine by half—to 0.1 milligrams per kilogram of body weight per day—and added a one-gram twice daily dose of CellCept. An average of 25 months after enrolling in the study, creatinine levels declined in 37 of the 60 patients and stabilized or increased further in the other 23 patients.
"Members of the University of Maryland Medical Center transplant team are so encouraged by their findings that the new therapeutic strategy is being used in all kidney transplant patients who experience erosion of their kidney function," the university reported.
In the second study, Eugene Schweitzer, MD, and colleagues used high PRA (panel reactive antibody) rescue in combination, for the first time, with three antirejection drugs: Prograf, CellCept, and IVIG. Eight patients with end-stage renal disease underwent plasmapheresis to cleanse their blood of their reactive antibodies, the presence of which would have led to immediate rejection of a new kidney. The antibodies were successfully removed in six of the eight patients, and all six went on to have successful kidney transplants from living donors between March 1998 and April 1999. No acute rejection episodes had occurred when the results of the study were reported at the ASTS meeting.
Although the concept of using plasmapheresis in patients with high PRA is a decade old and has produced low success rates, the investigators believe that "the new antirejection medications that the ... physicians used in combination with the plasmapheresis made a major difference," said the University of Maryland researchers.
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