BACKGROUND: Recent improvements in simultaneous pancreas-kidney transplantation (SPK) and the striking decrease in acute rejection lead us to focus on the effects of long-term immunosuppression. AIM OF THIS STUDY: Evaluation of a policy of steroid withdrawal and tailored immunosuppression in pancreas-kidney patients treated in a single center. METHODS: review of the clinical charts in 9 SPK recipients (male/female = 5/4, median age 41 years, median follow-up 42 months), by the same operator, under supervision of the two usual caregivers. Therapeutic protocols. Induction phase: all patients received mycophenolate mophetil (starting dose: 2 grams), tacrolimus and steroids, 8 received Simulect, 1 received thymoglobulins. Maintenance therapy was slowly reduced, with the goal of steroid withdrawal. RESULTS: The therapeutic adjustments were mainly determined by two almost opposing elements: 1. Rapid adjustments in the case of side-effects (gastrointestinal problems, infections and neoplasia); 2. Slow tapering off in the case of good organ function. On the other hand, a switch to cyclosporine A and to rapamycine was considered in the case of chronic organ malfunction. By these means, over a median of 42 months follow-up, steroid withdrawal was slowly obtained in 6/9 patients (at a median time of 25 months). CONCLUSIONS: Within the limits of this small-scale study, a tailored immunosuppressive policy allows at least some "positively selected" patients to reach the "dream" of steroid withdrawal after SPK.
BACKGROUND: Recent improvements in simultaneous pancreas-kidney transplantation (SPK) and the striking decrease in acute rejection lead us to focus on the effects of long-term immunosuppression. AIM OF THIS STUDY: Evaluation of a policy of steroid withdrawal and tailored immunosuppression in pancreas-kidneypatients treated in a single center. METHODS: review of the clinical charts in 9 SPK recipients (male/female = 5/4, median age 41 years, median follow-up 42 months), by the same operator, under supervision of the two usual caregivers. Therapeutic protocols. Induction phase: all patients received mycophenolate mophetil (starting dose: 2 grams), tacrolimus and steroids, 8 received Simulect, 1 received thymoglobulins. Maintenance therapy was slowly reduced, with the goal of steroid withdrawal. RESULTS: The therapeutic adjustments were mainly determined by two almost opposing elements: 1. Rapid adjustments in the case of side-effects (gastrointestinal problems, infections and neoplasia); 2. Slow tapering off in the case of good organ function. On the other hand, a switch to cyclosporine A and to rapamycine was considered in the case of chronic organ malfunction. By these means, over a median of 42 months follow-up, steroid withdrawal was slowly obtained in 6/9 patients (at a median time of 25 months). CONCLUSIONS: Within the limits of this small-scale study, a tailored immunosuppressive policy allows at least some "positively selected" patients to reach the "dream" of steroid withdrawal after SPK.
Authors: Bryan N Becker; Jon S Odorico; Yolanda T Becker; Marilyn Groshek; Cathy Werwinski; John D Pirsch; Hans W Sollinger Journal: J Am Soc Nephrol Date: 2001-11 Impact factor: 10.121
Authors: Dixon B Kaufman; Ron Shapiro; Michael R Lucey; Wida S Cherikh; Rami T Bustami; David B Dyke Journal: Am J Transplant Date: 2004 Impact factor: 8.086
Authors: M L Jordan; P Chakrabarti; P Luke; R Shapiro; C A Vivas; V P Scantlebury; J J Fung; T E Starzl; R J Corry Journal: Transplantation Date: 2000-01-27 Impact factor: 4.939
Authors: Robert J Stratta; M H Shokouh-Amiri; M Francesca Egidi; Hani P Grewal; Agnes Lo; A Tarik Kizilisik; Nosratollah Nezakatgoo; Lillian W Gaber; A Osama Gaber Journal: Clin Transplant Date: 2003 Impact factor: 2.863
Authors: Bertram L Kasiske; Jon J Snyder; Arthur J Matas; Mary D Ellison; John S Gill; Annamaria T Kausz Journal: J Am Soc Nephrol Date: 2002-05 Impact factor: 10.121
Authors: M Bassetti; P R O Salvalaggio; J Topal; M I Lorber; A L Friedman; V T Andriole; G P Basadonna Journal: J Hosp Infect Date: 2004-03 Impact factor: 3.926