Pilot study of early corticosteroid elimination after pancreas transplantation

Transplant Proc. 2005 Mar;37(2):1287-8. doi: 10.1016/j.transproceed.2004.12.072.

Abstract

Early corticosteroid withdrawal has recently been shown to be possible in recipients of simultaneous pancreas kidney transplants; however, its feasibility in solitary pancreas recipients has not been documented. In the present study, we provide evidence that early withdrawal can be achieved in pancreas as well as pancreas-kidney recipients.

Methods: Twenty type I diabetics underwent 13 pancreas-kidney transplants and 7 pancreas-only transplants with early withdrawal (methylprednisone 6-day taper). Additional immunosuppression consisted of tacrolimus, mycophenolate mofetil, and thymoglobulin induction (five doses).

Results: Transplants included 13 pancreas-kidney, 6 pancreas after kidney transplant, and 1 pancreas after islet transplant. Overall mean follow-up was 7.3 months. One episode of pancreas transplant rejection after pancreas-only transplant was detected on protocol biopsy without biochemical abnormalities. One renal allograft rejection occurred 65 days posttransplant in a pancreas-kidney recipient and was graded as a Banff IA rejection. A single pancreas graft loss occurred due to thrombosis 6 days after pancreas-kidney transplantation.

Conclusions: These results indicate that relatively short thymoglobulin induction (five doses) with tacrolimus and mycophenolate mofetil can allow early withdrawal in both pancreas-kidney and pancreas-only transplant recipients.

Publication types

  • Clinical Trial

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Diabetes Mellitus, Type 1 / surgery*
  • Diabetic Nephropathies / immunology
  • Diabetic Nephropathies / surgery
  • Drug Administration Schedule
  • Female
  • Graft Rejection / epidemiology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / physiology
  • Male
  • Ohio
  • Pancreas Transplantation / immunology
  • Pancreas Transplantation / physiology*
  • Pilot Projects
  • Racial Groups

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents