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Effect of intraportal human islet transplantation on kidney graft survival in simultaneous kidney-islet allografts

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  • Medicine

Abstract

· · · f ; , - Effect of Intraportal Human Islet Transplantation on Kidney Graft Survival in Simultaneous Kidney-Islet Allografts H.R. Rilo, P.B. Carroll, R. Shapiro, P. Fontes, V. Scantlebury, W. Irish, A.G. Tzakis, T.E. Starzl, and C. Ricordi AN increased frequency of acute kidney rejection episodes has been observed following simultaneous kidney and pancreas transplantation. 1-4 This has not been noted in all series.5•6 The mechanism of how the pancreas graft might induce rejection in the transplanted kidney is not known. We examined the frequency of kidney rejec- tion episodes in patients who underwent combined kid- ney-islet transplantation. METHODS Eight patients aged 29 to 38 years with long-standing insulin- dependent (type 1) diabetes mellitus received nine combined cadaveric kidney-islet grafts (one retransplant), with one (n = 6). two (n = 2), or three (n = I) islet donors. The cadaveric donor ABO types were all compatible with recipient types and HLA matching was random, the antigen match being 0 to 2 for the kidney and 0 to 3 for islets. All patients had a negative cross- match. One patient who underwent the procedure died on the fifth postoperative day of aspiration pneumonia. This was not included in the analysis of frequency of rejection, but data are included in the calculation of mortality and graft survival. Human islets were obtained as previously described.8 The islets were transplanted by infusion into a branch of the portal vein. All patients received a 1000-mg bolus of methylprednisolone during the operation, followed by a decreasing prednisone dose from 200 to 20 mg over the course of the first week posttransplant. FK 506 was given at a dose of 0.1 mWJ<g intravenously adminis- tered as a continuous infusion over 24 hours, beginning immedi- ately following transplantation. When patients resumed a solid diet, an oral dose of 0.15 mg/kg/BID was started. Patients 6 to 8 also received imuran 200 mg/d during the first postoperative w

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