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Immunosuppression

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Pancreas Transplantation
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Abstract

In clinical practice the recipient of a pancreatic organ graft requires treatment to modify the immune response so that the graft is able to survive within the host. This is usually achieved by the administration of nonspecific agents, which endeavor to create a compromise between the need for immunosuppression and the protection of the graft, and depleting the recipient’s own immune system such that overwhelming infection can occur. Agents such as steroids [1] and azathioprine [2] were the mainstay of clinical organ transplantation for over a decade and additional agents such as cyclosporine [3] and monoclonal antibodies [4] have only recently become available. Monoclonal antibodies themselves perhaps represent the first real attempt to be more selective in depletion of recipient target lymphocytes.

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References

  1. Billingham RE, Krohn PL, Medawar PB: Effect of cortisone on survival of skin homo-grafts in rabbits. Br Med J 1157:1951.

    Google Scholar 

  2. Elion GB, Callahan S, Bieber S, et al: A summary of investigations with 6-[(1 Methly-4-nitro-r-imidazolyl)thio]porine. Cancer Chemother Reports 14:93–98, 1961.

    CAS  Google Scholar 

  3. Borel JF, Feurer C, Magnee C, et al: Effects of the new antilymphocyte peptide cyclosporin A in animals. Immunology 32:1017, 1977.

    PubMed  CAS  Google Scholar 

  4. Cosimi AB: The clinical value of antilymphocyte antibodies. Transplant Proc 13:462, 1981.

    PubMed  CAS  Google Scholar 

  5. McMaster P: What to expect from pancreas transplantation. Transplant Proc 16:587, 1984.

    PubMed  CAS  Google Scholar 

  6. Cameron JS: Renal disease and diabetes. Diabetic Nephropathy 2:1, 1983.

    Google Scholar 

  7. Braun WE, Phillips DR, Viot DG: Coronary artery disease in 100 diabetics with end-stage renal failure. Transplant Proc 16:603, 1984.

    PubMed  CAS  Google Scholar 

  8. Kelly WD, Lillihei RC, Merkel FK: Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery 61:826, 1967.

    Google Scholar 

  9. Jurewicz WA, Buckels JAC, Dykes JGA, et al: 111-Indium platelets in monitoring pancreatic allografts in man. Br J Surg 72:228, 1985.

    Article  PubMed  CAS  Google Scholar 

  10. Sollinger HW, Kaylayoglu M, Hoffman RM, et al: Experience with pancreaticocystostomy in 24 consecutive pancreas transplants. Transplant Proc 17:141, 1985.

    Google Scholar 

  11. Morris PJ, Finch DR, Garvey JF: Suppression of rejection of allogenic islet tissue in the rat. Diabetes 29 (suppl 1):107, 1980.

    PubMed  Google Scholar 

  12. Lacy PE: Experimental immuno-alteration. World J Surg 8:198, 1984.

    Article  PubMed  CAS  Google Scholar 

  13. Sharp DW, Murphy JJ, Newton WT: Transplantation of islets of Langerhans in diabetic rhesus monkeys. Surgery 77:100, 1975.

    Google Scholar 

  14. Hardy MA, Lau HT, Weber C, et al: Pancreatic islet cell transplantation: Immunoalteration with ultraviolet irradiation. World J Surg 8:207, 1984.

    Article  PubMed  CAS  Google Scholar 

  15. Alfani D, Marinucci G, Renna Molajoni E, et al: Combined immunosuppressive clinical protocol: Experience with total lymphoid irradiation plus cyclosporine. Transplant Proc 17:(suppl 2):49, 1985.

    Google Scholar 

  16. Germuth FG, Ottinger B: Effect of 17-hydroxy-11-dehydrocorticosterone (compound E) and of ACTH on Arthus reaction and antibody formation in rabbit. Proc Exp Biol Med 74:815, 1950.

    CAS  Google Scholar 

  17. Bach JF: The Mode of Action of Immunosuppressive Agents, Vol 41. New York: American Elsevier, 1975, p 379.

    Google Scholar 

  18. Goodwin WE, Kaufman JJ, Mims MM, et al: I. Clinical experiences with six cases of renal transplantation. J Urol 89:13, 1963.

    PubMed  CAS  Google Scholar 

  19. McGeown MG, Kennedy JA, Loughridge WGG, et al: One hundred transplants in the Belfast City Hospital. Lancet 2:648, 1977.

    Article  PubMed  CAS  Google Scholar 

  20. Chan L. French ME, Beare J, et al: Prospective trial of high-dose versus low-dose prednisolone in renal transplant patients. Transplant Proc 12:323, 1980.

    PubMed  CAS  Google Scholar 

  21. Bach MA, Bach JF: Activities of immunosuppressive agents in vitro. II. Different timing of azathioprine and methotrexate in inhibition and stimulation of mixed lymphocyte reaction. Clin Exp Immunol 11:89. 1972.

    PubMed  CAS  Google Scholar 

  22. Bach JF, Dardenne M: Antigen recognition by T lymphocytes. II. Similar effects of azathioprine, antilymphocyte serum and anti-theta serum on rosette forming lymphocytes in normal and neonatally thymectomized mice. Cell Immunol 3:11, 1972.

    Article  PubMed  CAS  Google Scholar 

  23. Calne RY: The rejection of renal homografts: Inhibition in dogs by 6-mercaptopurine. Lancet 1:417, 1960.

    Article  PubMed  CAS  Google Scholar 

  24. Calne RY: Inhibition of the rejection of renal homografts in dogs by purine analogues. Transplant Bull 28:65, 1961.

    Article  PubMed  CAS  Google Scholar 

  25. Hume DM, Magee JH, Prout GR, et al: Studies of renal homotransplantation in man. Ann NY Acad Sci 120:578, 1964.

    PubMed  CAS  Google Scholar 

  26. Borel JF: The history of cyclosporin A and its significance. In Cyclosporin A, White DJ (ed). Amsterdam: Elsevier Biomedical, 1982, p 5.

    Google Scholar 

  27. Calne RY, Rolles K, White DJ: Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers. Lancet 2:1033, 1979.

    Article  PubMed  CAS  Google Scholar 

  28. Calne RY, White DJ: Use of cyclosporin A in clinical organ grafting. Ann Surg 196:330, 1982.

    Article  PubMed  CAS  Google Scholar 

  29. Lafferty K, Borel JK, Hodgkin D: Cyclosporin A (CsA): Models for the mechanism of action. Transplant Proc 15:2242, 1983.

    CAS  Google Scholar 

  30. European Multicentre Trial Group: Cyclosporin A as sole immunosuppressive agent in recipients of kidney allografts from cadaver donors. Lancet 2:57, 1982.

    Google Scholar 

  31. Canadian Multicenter Transplant Study Group: A randomized clinical trial of cyclosporin in cadaveric renal transplantation. N Engl J Med 209:809, 1983.

    Google Scholar 

  32. Kahan BD, Kerman RH, Agostino G, et al: The action of cyclosporin a on human lymphocytes. In Cyclosporin A White DJ (ed). Amsterdam: Elsevier Biomedical, 1982, p 281.

    Google Scholar 

  33. Rynasewicz J, Sutherland DER, Wawahara K, et al: Cyclosporin A prolongation of segmental pancreatic and islet allograft function in rats. Transplant Proc 12:270, 1980.

    Google Scholar 

  34. McMaster R, Procyshin A, Calne RY, et al: Prolongation of canine pancreas allograft survival with cyclosporin A: Preliminary report. Br Med J 280:444, 1980.

    Article  PubMed  CAS  Google Scholar 

  35. Dutoit DF, Reece-Smite H, McShane P, et al: Prolongation of segmental pancreatic allografts in dogs receiving cyclosporin A. Transplantation 33:432, 1982.

    CAS  Google Scholar 

  36. Garvey JFW, Deane SA, Grierson JM, et al: Effect of cyclosporine A on segmental pancreas allografts in the dog. Transplant Proc 16:1043–1045, 1986.

    Google Scholar 

  37. DuToit DF, Heydenrych J, Louw G, et al: The effect of cyclosporine alone and in combination with steroids on experimental segmental pancreatic allografts in the baboon. Transplant Proc 15:2992, 1983.

    CAS  Google Scholar 

  38. Prieto M, Sutherland DER, Fernandez-Cruz L, et al: Early diagnosis and treatment of rejection in pancreas transplantation. Transplant Proc 18:1805–1806, 1984.

    Google Scholar 

  39. Woodruff MFA, Foritan B, Fraser KB: Effect of antilymphocytic serum on circulating antibody levels. J Immunol 67:57, 1951.

    PubMed  CAS  Google Scholar 

  40. Starzl TE, Marchioro TL, Porter KA, et al: The use of heterologous antilymphoid agents in canine renal and liver homotransplantation and in human renal homotransplantation. Surg Gynecol Obstet 124:301, 1967.

    PubMed  CAS  Google Scholar 

  41. Cosimi AB, Burton RC, Russell PS: Evaluation in primate renal allograft recipients of monoclonal antibody to human T-cell subclasses. Transplant Proc 13:499, 1981.

    PubMed  CAS  Google Scholar 

  42. Bell PRF, Blarney RW, Briggs JD, et al: Medical research council trial of antithymocyte globulin in renal transplantation: A multicenter randomized double-blind placebo controlled clinical investigation. Transplantation 35:539, 1983.

    Article  PubMed  CAS  Google Scholar 

  43. Kreis H, Mansouri R, Descamps J, et al: Antithymocyte globulin in cadaver kidney transplantation: A randomized trial based on T-cell monitoring. Kidney Int 19:438, 1981.

    Article  PubMed  CAS  Google Scholar 

  44. Cosimi AB, Colvin PC, Hansen WP, et al: Use of monoclonal antibodies to T-cell subsets for immunologic monitoring and treatment in recipients of renal allografts. N Engl J Med 305:308, 1981.

    Article  PubMed  CAS  Google Scholar 

  45. Jonker M, Goldstein G, Balner H: Effects of in vivo administration of monoclonal antibodies specific for human T cell subpopulations on the immune system of a rhesus monkey model. Transplantation 35:521, 1983.

    Article  PubMed  CAS  Google Scholar 

  46. Dempster WJ, Lennox B, Boag JW: Prolongation of survival of skin homotransplants in rabbit by irradiation of host. Br J Exp Pathol 31:670, 1950.

    PubMed  CAS  Google Scholar 

  47. Slavin S. Kaplan HS, Strober S: Transplantation of allogeneic bone marrow without graft versus host disease using total lymphoid irradiation. J Exp Med 147:963, 1978.

    Article  PubMed  CAS  Google Scholar 

  48. Surmont J, Dutreix A, LaLanne CM: J Radiol Electrol 41:679, 1966.

    Google Scholar 

  49. Myburgh JA, Smit JA, Hill RRH: Transplantation tolerance in primates following total lymphoid irradiation and allogeneic bone marrow injection. Transplantation 29:405, 1980.

    Article  PubMed  CAS  Google Scholar 

  50. DuToit DF, Heydenrych JJ, Smit B, et al: Segmental pancreatic allograft survival in pan-createctomized baboons treated with total body or lymphoid irradiation and preoperative blood transfusions. Transplant Proc 16:804, 1984.

    Google Scholar 

  51. DuToit DF, Heydenrych JT, Smith B, et al: Segmental pancreatic allograft survival in baboons treated with combined irradiation and cyclosporine: A preliminary report. Surgery 97:447, 1985.

    CAS  Google Scholar 

  52. Traeger J, Dubernard JM, Bosi E, et al: Patient selection and risk factors in organ transplantation in diabetics: Experience with kidney and pancreas. Transplant Proc 16:577, 1984.

    PubMed  CAS  Google Scholar 

  53. Groth CG, Lundgren G, Arner P, et al: Rejection of isolated pancreatic allografts in patients with diabetes. Surg Gynecol Obstet 143:933, 1976.

    PubMed  CAS  Google Scholar 

  54. Jervell J, Dahl BD, Fauchald P, et al: Clinical results of renal transplantation in diabetic patients. Transplant Proc 16:599, 1984.

    PubMed  CAS  Google Scholar 

  55. Sutherland DER, Chinn PL, Goetz FC, et al: Minnesota experience with 81 pancreas transplants since 1978. Transplant Proc 16:695, 1984.

    PubMed  CAS  Google Scholar 

  56. International Pancreas Transplant Registry, 1986. Sutherland update.

    Google Scholar 

  57. Land W, Landgraf R, Illner WD, et al: Improved results in combined segmental pancreatic and renal transplantation in diabetics under cyclosporine therapy. Transplant Proc 17:317, 1985.

    Google Scholar 

  58. Tyden G, Wilczek H, Lundgren G, et al: Experience with 21 intraperitoneal segmental pancreatic transplants with enteric or gastric exocrine diversion in humans. Transplant Proc 17:317, 1985.

    Google Scholar 

  59. Salaman JR, Griffin PGA: Immunosuppression with a combination of cyclosporin, azathioprine, and prednisolone may be unsafe. Lancet 2:1066, 1985.

    Article  PubMed  CAS  Google Scholar 

  60. Canafax D, Sutherland DER, Fryd DS et al: The benefits of immunosuppressive drug combinations for diabetic recipients of cadaver and HLA mismatched renal allografts. Transplant Proc 18:1728–1729, 1987.

    Google Scholar 

  61. Sollinger HW: Personal communication, 1987.

    Google Scholar 

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© 1988 Kluwer Academic Publishers

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McMaster, P. (1988). Immunosuppression. In: Toledo-Pereyra, L.H. (eds) Pancreas Transplantation. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1735-7_11

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  • DOI: https://doi.org/10.1007/978-1-4613-1735-7_11

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-8976-0

  • Online ISBN: 978-1-4613-1735-7

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