Featured Research

from universities, journals, and other organizations

Jefferson Liver Transplant Surgeons Show Less Rejection, Better Survival With Drug Regimen

Date:
September 24, 2004
Source:
Thomas Jefferson University
Summary:
Transplant surgeons at Thomas Jefferson University Hospital in Philadelphia have found that a new combination of drugs results in fewer incidences of rejection in liver transplant patients than do current treatments.

Transplant surgeons at Thomas Jefferson University Hospital in Philadelphia have found that a new combination of drugs results in fewer incidences of rejection in liver transplant patients than do current treatments.

Surgeons, led by Ignazio Marino, M.D., director of the Division of Liver Transplantation and Hepato-biliary Surgery at Thomas Jefferson University Hospital, analyzed the results of 50 liver transplant procedures they performed between 2000 and 2002. To try to prevent or lessen the severity of rejection, Dr. Marino's group used a monoclonal antibody, basiliximab, as part of a group of drugs that included tacrolimus, a standard anti-rejection agent, and low doses of steroids. Basiliximab, which ties up an important immune system cell (IL-2) receptor, has been used for kidney transplantation.

The group found a much lower incidence of liver rejection.

"When we added basiliximab, the rate of rejection dropped dramatically to 12 percent," says Dr. Marino, who is also professor of surgery at Jefferson Medical College of Thomas Jefferson University and the interim director of the Division of Transplantation at Thomas Jefferson University Hospital. He notes that the rate, which is after one year, is comparable to a French study that showed that 38 percent of patients had a rejection episode in the first year. Another trial conducted by the University of Pittsburgh had a 45 percent rejection rate after one year.

"The big advantage [of this combination of drugs] is that the incidence of rejection is significantly decreased," he says. "These results could change the standard of care for liver transplant recipients."

The study findings appear Sept. 27, 2004 in the journal Transplantation. The results show that the drugs may have helped improve survival as well. Of the 50 patients who received transplants, 88 percent were alive three years later (The actuarial survival rate at three years was 88 percent.). According to the Transplant Liver Registry of the United Network for Organ Sharing, approximately 78 percent of those who receive liver transplants live for at least three years.

Dr. Marino notes that in the past 15 months of using this combination of drugs for liver transplants at Jefferson, the one-year patient survival is 100 percent.

According to Dr. Marino, in the 1990s at the University of Pittsburgh, surgeons developed a tacrolimus-based drug combination that changed the face of liver transplantation. Its use greatly decreased the reliance on steroids, which can produce nasty side effects, but high doses of the drug caused neurotoxicity and kidney toxicity. In the last decade, surgeons began using antibodies that were given to the patient initially before surgery in an attempt to reduce side effects from high doses of tacrolimus.

Tacrolimus is a drug that suppresses the immune system by inhibiting an enzyme (calcineurin) crucial for T-cell proliferation, which is important in the immune process. The Jefferson surgeons' trial marks the first time anyone had evaluated the effectiveness and safety of basiliximab and tacrolimus to suppress the immune system to prevent the body's rejection of a liver.

"We think we have much less toxicity in the short term because we use less tacrolimus," he says. They also expect less toxicity in the long term as well because they used fewer steroids. As a result, he says, they expect fewer complications associated with long-term steroid use, which includes hypertension, osteoporosis and diabetes.

Dr. Marino has also discovered that basiliximab may affect hepatitis C virus (HCV) recurrence. "We also suspect that the recurrence of HCV is lower, though we don't have enough data to confirm this," he says. Typically, immunosuppressed liver transplant patients experience high rates of HCV recurrences, Dr. Marino notes, because the virus has fewer restrictions on its growth. Perhaps, he says, the anti-IL2 monoclonal has some mechanism affecting the replication of the HCV.

"If this observation can be confirmed, it's important news because 60 percent of the patients we transplant are diagnosed with HCV. This would mean an immunosuppression that can delay the recurrence of HCV on top of having fewer episodes of rejection and toxicity than before."

While Dr. Marino says that he would like to continue to investigate whether these drugs indeed reduce the recurrence of HCV, he has another clinical trial in mind.

"We would like to begin a new study with no steroids – just two doses of this new drug at the time of the liver transplant and then tacrolimus for life," he says.

"We think in the long term, we need to shift the paradigm of immune suppression," he says. "We may someday be able to wean patients away from immune suppression."


Story Source:

The above story is based on materials provided by Thomas Jefferson University. Note: Materials may be edited for content and length.


Cite This Page:

Thomas Jefferson University. "Jefferson Liver Transplant Surgeons Show Less Rejection, Better Survival With Drug Regimen." ScienceDaily. ScienceDaily, 24 September 2004. <www.sciencedaily.com/releases/2004/09/040923100057.htm>.
Thomas Jefferson University. (2004, September 24). Jefferson Liver Transplant Surgeons Show Less Rejection, Better Survival With Drug Regimen. ScienceDaily. Retrieved September 23, 2014 from www.sciencedaily.com/releases/2004/09/040923100057.htm
Thomas Jefferson University. "Jefferson Liver Transplant Surgeons Show Less Rejection, Better Survival With Drug Regimen." ScienceDaily. www.sciencedaily.com/releases/2004/09/040923100057.htm (accessed September 23, 2014).

Share This



More Health & Medicine News

Tuesday, September 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Liberia Pleads for Help to Fight Ebola

Liberia Pleads for Help to Fight Ebola

AP (Sep. 22, 2014) Liberia's finance minister is urging the international community to quickly follow through on pledges of cash to battle Ebola. Bodies are piling up in the capital Monrovia as the nation awaits more help. (Sept. 22) Video provided by AP
Powered by NewsLook.com
Ebola Doctor Says Border Controls Critical

Ebola Doctor Says Border Controls Critical

AP (Sep. 22, 2014) A Florida doctor who helped fight the expanding Ebola outbreak in West Africa says the disease can be stopped, but only if nations quickly step up their response and make border control a priority. (Sept. 22) Video provided by AP
Powered by NewsLook.com
Global Ebola Aid Increasing But Critics Say It's Late

Global Ebola Aid Increasing But Critics Say It's Late

Newsy (Sep. 21, 2014) More than 100 tons of medical supplies were sent to West Africa on Saturday, but aid workers say the global response is still sluggish. Video provided by Newsy
Powered by NewsLook.com
Sierra Leone in Lockdown to Control Ebola

Sierra Leone in Lockdown to Control Ebola

AP (Sep. 21, 2014) Sierra Leone residents remained in lockdown on Saturday as part of a massive effort to confine millions of people to their homes in a bid to stem the biggest Ebola outbreak in history. (Sept. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins