Children's surgeon to present results of new anti-rejection protocol at World Transplant Congress

Children's Hospital of Pittsburgh Surgeon and Researcher Rakesh Sindhi, MD, to discuss new protocol that has shown to improve patient outcomes

PITTSBURGH July 19, 2006 A Children's Hospital of Pittsburgh surgeon and researcher will present study results that show intestinal transplant recipients had significantly improved outcomes due to a new low-dose, anti-rejection protocol.

Research performed by Rakesh Sindhi, MD, Co-Director of Pediatric Transplantation, and associates at Children's Hospital of Pittsburgh, shows that the new protocol reduces drug doses and eliminates steroids altogether in young patients. Dr. Sindhi, also an Associate Professor of Surgery at the University of Pittsburgh School of Medicine, will present four studies at the World Transplant Congress in Boston on July 24 and 25, 2006 with all ranking in the top 10 percent of all research selected.

A total of 75 Children's patients, who have received an intestine transplant, alone or with the liver over a four-year period using the new protocol, were reviewed. The results show a survival rate of 84 percent in the third year of follow-up. Comparably, the international survival rate average for intestine transplant recipients is 70 percent in the second year follow-up. The anti-rejection protocol was originally proposed by Thomas E Starzl, MD, PhD, in 2000 at the University of Pittsburgh.

"We were pleased and encouraged by the results of this protocol, which included greatly reduced infections, lymphoma-like disorders, and measurable benefits in the rate of height and weight gain, than were seen with previous higher dose regimens," Dr. Sindhi said. "Improved survival rates have focused more attention on finding ways to make recovery less difficult and give children a quality of life vastly better than what patients could expect a decade earlier. The most difficult period of recovery for child and family is typically the first year after transplantation. As the child's condition improves, improvement in the child's quality of life typically follows.

Also being presented are two new strategies being developed in Children's Pediatric Transplant Laboratory. The first determines the risk of rejection by replicating the transplant reaction between the child and his or her donor in a test tube. Results from 45 children suggest that future use of this type of testing may be to identify when anti-rejection drugs may be reduced safely, without causing organ rejection.

The second approach evaluates whether a child's predisposition to organ rejection, rejection-free state and tolerance is based on inherited abnormalities in the genetic code for "immune response" genes. Dr. Sindhi adds that although tolerance is a rare, it is an ideal outcome, whereby anti-rejection medications are no longer required.

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Transmission of more than 2,300 mutations has been evaluated in 170 samples from more than 60 children and their biological parents. Results suggest that transplant outcomes and response to drugs are both associated with unique "genomic fingerprints." Components of these genomic fingerprints are point mutations, as well as variations in the amount of DNA inherited from each parent. Future applications of such fingerprints include selection of the right drug and its amount for each child prior to transplantation. For more information about Children's Pediatric Transplant Program, Dr. Sindhi or more, please visit www.chp.edu.


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