Pilot Study of Early Corticosteroid Elimination After Pancreas Transplantation

• Published in: Transplantation proceedings Vol. 37; no. 2; pp. 1287 - 1288
• Main Authors: Hanaway, M.J., Roy-Chaudhury, P., Buell, J.F., Thomas, M., Munda, R., Alloway, R.R., Ellison, V., Rudich, S.M., Fisher, L., Woodle, E.S.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2005; Elsevier Science
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adult; Biological and medical sciences; Continental Population Groups; Diabetes Mellitus, Type 1 - surgery; Diabetic Nephropathies - immunology; Diabetic Nephropathies - surgery; Drug Administration Schedule; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - epidemiology; Humans; Immunosuppressive Agents - therapeutic use; Kidney Failure, Chronic - surgery; Kidney Transplantation - physiology; Male; Medical sciences; Ohio; Pancreas Transplantation - immunology; Pancreas Transplantation - physiology; Pilot Projects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Ohio; Medicine; Corticosteroid; Treatment; Surgery; Graft; Early; Transplantation; Homotransplantation; Pancreas
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.12.072

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.
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).
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.
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.