*7.3.2. Abdominal CT scan*

In some cases, Doppler ultrasound may be technically limited (abdominal distension, obesity) or the study might need to be extended, such as in the patient with abdominal pain, fever, and/or graft dysfunction, intra-abdominal collection not accessible to ultrasound drainage, intra-abdominal collection drained by ultrasound, but without adequate clinical response. If a vascular pathology or bleeding is suspected, a contrast-enhanced CT scan is advised.

Immunosuppression is usually dived into two major categories—induction and maintenance. The former represents treatments used in the peri-transplant period alone, with the objective of inhibiting both the innate and adaptative immune response when the graft is first exposed to recipient immune system. The drugs used are the same as for other solid organ transplantations and have been described in other chapters. The next section describes how and what

Pancreas Transplantation

279

http://dx.doi.org/10.5772/intechopen.76667

This consists of the administration of a polyclonal or monoclonal antibodies and is currently assumed as standard treatment for pancreas transplantation. These decrease the incidence of acute rejection or delay its onset, and reduce the number of steroid-resistant rejections. Depleting T-cell antibodies may be polyclonal, most widely used, such as rabbit anti-thymocyte globulin (Thymoglobulin®/ATG-Fresenius®) or monoclonal, such as the anti-CD52 alemtuzumab (Campath®); among non-depleting monoclonal antibodies, anti-IL-2 receptor

There is no consensus on which is the best protocol. Depleting antibodies appear to increase graft survival by reducing acute rejection risk [8] and are the most widely used. Nonetheless, due to financial constraints and also due to an increased infection and cancer risk associated with T-cell depleting agents, some groups use monoclonal anti-IL-2 antibodies in low-immu-

As an adjunctive treatment to induction therapy, and as long-term maintenance immunosuppression, a combination of three drugs is most often used: a calcineurin inhibitor (CNI), an

The discovery of cyclosporine 35 years ago marked a new era in solid organ transplantation. The incidence of acute rejection was drasticly reduced, and despite an increased risk for renal calcineurin toxicity and subsequent renal failure, the patient and graft survivals observed a spetacular improvement. Tacrolimus (or FK-506), also a CNI, exhibits a better and more potent immunsoppression profile and is currently considered the drug of choice in pancreas transplantation. CNI's act by inhibiting the transduction of the first signal between antigenpresenting cells and T-cells. Several comparative studies have shown a lower incidence of acute rejection, as well as a lower severity of rejection and a better survival of the pancreatic

CNI is often associated with an anti-prolipherative agent. Their action focuses on a different pathway of the T- and B-cell activation and prolipheration. Azathioprine, the first to be used, arrests cell cycle in the G2 phase, inhibiting the progress to the M phase and subsequent clonal expansion. On the other hand, antimetabolite agents (mycophenolate-mofetil or mycophenolate sodium) inhibit nucleotide syntisis, removing the substrate to DNA replication, finally achieving the same result as azathioprine—prevents cell prolipheration. Finally, the latest agent to be introduced to solid organ transplantation were mammalian target of rapamycin

graft in the short and long term, in those patients treated with tacrolimus.

drugs are used in pancreas transplantation:

(anti-CD-25; basiliximab) is the most frequently used.

nological risk simultaneous pancreas-kidney tranplantation.

*8.1.1. Induction therapy*

*8.1.2. Maintenance treatment*

anti-prolipherative, and steroids.
