Technical and Immunosuppressive Advances in Transplantation forInsulin‐Dependent Diabetes Mellitus

Abstract

Pancreas transplantation has emerged as the single most effective way to achieve normal glucose homeostasis inpatients with type I insulin-dependent diabetes mellitus. Optimal immunosuppressive strategies for pancreas transplantation continue to evolve with the use of newer, more potent immunosuppressive agents,particularly tacrolimus, mycophenolate mofetil, and rapamycin. These agents have contributed to substantially lower rates of allograft rejection and improved graft survival. Regimens designed to avoid nephrotoxicity or spare corticosteroid therapy are emerging as the variety of drug options grows. Also contributing to progressively better results for solitary pancreas transplants are reductions in early graft loss rates and the development of safe, effective biopsy techniques, permitting accurate diagnosis of rejection. Collectively,these factors have allowed solitary pancreas allograft recipients, a group of patients with historically poor long-term graft survival, to enjoy successes nearly equivalent to those of combined kidney-pancreas transplants. Consequently, the American Diabetes Association strongly endorses pancreas transplantation in diabetic patients who have received prior kidney transplants and who have life-threatening metabolic lability.

Selective, efficient modulation of activated CD4+ αβT cells by the novel humanized antibody GZ-αβTCR targeting human αβTCR

“…Thus, immunosuppression has to carefully balance toxicity and rejection. [6][7][8][9] Most of the current immunosuppressive regimens combine corticosteroids, calcineurin inhibitors (cyclosporine, tacrolimus), antimetabolites (mycophenolate mofetil, mycophenolic acid) and biologics [2][3][4]9 that are-to reduce side effects-tailored to each patient's needs. Nevertheless, pharmacologics targeting initiators of alloreactivity more specifically are urgently needed.…”

“…1 Despite immunoprophylaxis, allograft rejection is still a major obstacle for transplantation success, necessitating lifelong immunosuppression [2][3][4][5] with the well-known risk of infection, malignancy and chronic renal failure. Thus, immunosuppression has to carefully balance toxicity and rejection.…”

Comportamiento diferencial del paciente diabético en relación al no diabético en Hemodiálisis, en el hospital provincial de Camagüey, Cuba

“…Estas son, entre otras, valorar cuidadosamente el peso seco (peso que debe tener el paciente al acabar la diálisis, una vez que se elimina el exceso de líquido del cuerpo, con buena tolerancia por parte del paciente y sin producir hipotensión), motivar al paciente para que no tenga excesivas ganancias de peso interdiálisis, evitar las ultrafiltraciones agresivas, aumentar el número de sesiones o su duración, evitar la toma de fármacos hipotensores antes de la diálisis, mantener un adecuado control de la anemia y de la nutrición y usar perfiles de sodio en el baño de diálisis que permitan manejar mejor el volumen [62][63][64] .…”

“…Por otro lado, la gastroparesia diabética puede provocar una absorción errática de los alimentos, produciendo episodios tanto de hiperglucemia como de hipoglucemia. Por ello, para mejorar los síntomas, se recomienda a estos pacientes ingerir los alimentos en pequeñas cantidades y varias veces al día [63][64][65] .…”

“…Como segunda alternativa, se plantea la realización de una FAV humerocefálica. Como última opción, porque presenta más complicaciones, se contempla la creación de una fistula protésica o la colocación de un catéter venoso central [63][64][65] .…”