UPMC On Topic Transcript
Pittsburgh Protocol: Reducing the Risk of Immunosuppression
Vijay Gorantla, MD, PhD
Administrative Medical Director, Reconstructive Transplant Program
The Pittsburgh Protocol is an innovative therapy that has been developed by UPMC.
Traditional immunosuppression, that has been used in both hand and face transplants around the world, has relied on a combination of immunosuppressive agents, usually two or more drugs taken for a lifetime.
The idea being that if you use these different drugs which act on different pathways of the immune system, you can reduce the individual doses of each of these drugs. But in reality, patients end up taking high doses of these drugs, which can increase their risk of complications, from diabetes, high blood pressure, high cholesterol, kidney failure, or even in rare cases, cancer.
Novel approach
We at UPMC, including others, have felt strongly that the risk/benefit balance in reconstructive procedures such as hand and face transplants, is not worth it if using multiple immunosuppressive drugs.
The Pittsburgh Protocol is an innovative therapy because it involves initial treatment of the patient with what are called antibody treatment. This antibody treatment is done on the day of surgery it removes those cells in the recipient’s body that attack the graft immediately after it is transplanted.
A week after immunosuppressive therapy is started, the patient receives a single time infusion of bone marrow cells from the donor and the patients are then maintained with a single immunosuppressive drug.
The rationale being that the donor bone marrow cells contain what are called stem cells, which could potentially educate the recipient’s immune system in accepting, into accepting the hand or face transplant as self and the patients are then maintained with the single immunosuppressive drug.
Studies have also shown that this drug, Tacrolimus, improves the growth of nerves after transplantation, in addition to preventing rejection. Thus our protocol benefits not only the survival of the transplant but also return of function.
A successful track record
There is experience at UPMC in using Pittsburgh Protocol in other organ transplants like liver transplants and kidney transplants.
Some patients have been weaned completely off of immunosuppressive drugs and several others are maintained on a single drug as is the case with our hand transplant patients at very low doses.
We have achieved low doses of immunosuppression to date and we hope to eventually eliminate, reduce, if not eliminate patients from immunosuppression.
For more information, contact us at 412-648-9207.