A History of Antirejection Therapy and Pancreas Transplantation (1966-1998)

| Dec 1, 1998

1966 First pancreas transplant performed at the University of Minnesota.

1966 to 1980 Pancreas transplants, which were performed worldwide, are characterized by a series of poor success rates.

1980 The International Pancreas Trasplant Registry reports a one-year graft survival rate of 21 percent and patient survival rate of 67 percent. Nephrologists and diabetologists are reluctant to refer patients for pancreas transplants.

1983 First report on the method of Bladder Drainage (BD) is published by the Division of Organ Transplantation at the University of Wisconsin. BD becomes an accepted technique for exocrine pancreatic drainage, and results in a decreased incidence in post surgical complications.

1985 Cyclosporine A (Sandimmune) and OKT (Muromonab) are added to the immunosuppressant arsenal to treat postsurgical pancreas rejection. Both demonstrate a substantially better short-term graft survival.

Immunosuppressant protocol consists of a quadruple regimen of azathlopine, prednisone, cyclosporine A, and a 14-day course of Minnesota antilymphocyte globulin (MALG).

1987 Pancreas transplantation was still bogged down by what was a 75 percent incidence of organ rejection. Furthermore, such transplants also induced urinary and exocrine complications.

The UW Solution is invented at the University of Wisconsin School of Medicine, and is used to keep the pancreas alive during transportation between the donor and the recipient. Thrombosis, or pancreas rejection complications, are reduced from 22 percent to 0.3 percent in pancreas transplant subjects at the University of Wisconsin.

1991 A 14-day course of OKT replaces MALG in the immunosuppressive regimen that accompanies azathiprine, prednisone and cyclosprine A.

1993 Two immunosuppressants, tacrolimus (Prograf) and mycophenolate (CellCept) are introduced, and are proven to reduce the risk of pancreas transplant rejection, as well as improving short and long-term function. Mycrophenolate alone reduces the incidence of acute rejection episodes by more than 50 percent, and increases the one-year graft survival rate by 10 percent.

1995 Neoral (an emulsified formulation of Sandimmune cyclosporine A) and CellCept become commercially available.

1998 The University of Wisconsin School of Medicine releases the results of the largest and longest follow-up to date for patients with simultaneous pancreas-kidney transplants. A high success rate after one, five and ten years is confirmed in 500 patients with diabetes.

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Categories: Diabetes, History, Islet & Pancreas Transplant

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