Rajinder P Singh1, Robert J Stratta. 1. Department of General Surgery, Section of Transplantation, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Abstract
PURPOSE OF REVIEW: A review of current literature was performed to identify trends and evaluate outcomes with regard to clinical immunosuppression in pancreas transplantation. RECENT FINDINGS: Through 2006, over 20 000 pancreas transplantations were performed in the US. Since 2000, the 1-year patient survival rates for the three pancreas transplantation categories--simultaneous pancreas-kidney, sequential pancreas after kidney, and pancreas alone--were 95-97% and the 1-year pancreas graft survival (complete insulin independence) rates were 85%, 78%, and 77%, respectively. One-year rates of rejection have steadily decreased and are currently in the 10-20% range depending on case mix and immunosuppressive regimen. At present, 88% of recipients receive antibody induction, 65% receive maintenance therapy with the tacrolimus/mycophenolate mofetil combination, and 40-50% undergo corticosteroid withdrawal without adverse consequences. Limited data with tacrolimus/sirolimus reveal excellent short-term outcomes, whereas initial attempts with calcineurin inhibitor avoidance or minimization are less promising. SUMMARY: Antibody induction and either tacrolimus/mycophenolate mofetil or tacrolimus/sirolimus maintenance therapy with steroid withdrawal have become the mainstay of contemporary immunosuppression in clinical pancreas transplantation. The development of a nonnephrotoxic, nondiabetogenic, and nongastrointestinal toxic regimen, however, is highly desirable to improve outcomes and quality of life in recipients.
PURPOSE OF REVIEW: A review of current literature was performed to identify trends and evaluate outcomes with regard to clinical immunosuppression in pancreas transplantation. RECENT FINDINGS: Through 2006, over 20 000 pancreas transplantations were performed in the US. Since 2000, the 1-year patient survival rates for the three pancreas transplantation categories--simultaneous pancreas-kidney, sequential pancreas after kidney, and pancreas alone--were 95-97% and the 1-year pancreas graft survival (complete insulin independence) rates were 85%, 78%, and 77%, respectively. One-year rates of rejection have steadily decreased and are currently in the 10-20% range depending on case mix and immunosuppressive regimen. At present, 88% of recipients receive antibody induction, 65% receive maintenance therapy with the tacrolimus/mycophenolate mofetil combination, and 40-50% undergo corticosteroid withdrawal without adverse consequences. Limited data with tacrolimus/sirolimus reveal excellent short-term outcomes, whereas initial attempts with calcineurin inhibitor avoidance or minimization are less promising. SUMMARY: Antibody induction and either tacrolimus/mycophenolate mofetil or tacrolimus/sirolimus maintenance therapy with steroid withdrawal have become the mainstay of contemporary immunosuppression in clinical pancreas transplantation. The development of a nonnephrotoxic, nondiabetogenic, and nongastrointestinal toxic regimen, however, is highly desirable to improve outcomes and quality of life in recipients.
Authors: A M Posselt; M D Bellin; M Tavakol; G L Szot; L A Frassetto; U Masharani; R K Kerlan; L Fong; F G Vincenti; B J Hering; J A Bluestone; P G Stock Journal: Am J Transplant Date: 2010-08 Impact factor: 8.086
Authors: S Moassesfar; U Masharani; L A Frassetto; G L Szot; M Tavakol; P G Stock; A M Posselt Journal: Am J Transplant Date: 2015-11-23 Impact factor: 8.086
Authors: Phuoc H Pham; Lily N Stalter; Eric J Martinez; Jesse F Wang; Bridget M Welch; Glen Leverson; Nicholas Marka; Talal Al-Qaoud; Didier Mandelbrot; Sandesh Parajuli; Hans W Sollinger; Dixon Kaufman; Robert R Redfield; Jon S Odorico Journal: Am J Transplant Date: 2021-01-15 Impact factor: 9.369