Very early steroid withdrawal in simultaneous pancreas-kidney transplants

Abstract

A short induction with ATG and steroids associated with a chronic therapy with CellCept and tacrolimus is safe and efficient in preventing acute renal rejection in SPK.

Pancreas after kidney transplantation

“…The separate donor origins of the pancreas and the kidney in the PAK transplant recipients may account for some of these findings. The current direction of the field is induction with T-cell-depleting antibody with steroid withdrawal [23][24][25][26][27][28][29][30][31][32]. If the organs are from different donors, as is the case for PAK transplants, they may reject independently.…”

“…Following an SPK transplant, episodes of acute cellular rejection are more often detected and treated early because the recipients will manifest rejection of the transplanted kidney with a rise in serum creatinine, and the renal allograft is easily amenable to percutaneous biopsy. The depleting antibodies used include rabbit antithymocyte globulin [23,25,26,29,30,33] or alemtuzumab (anti-CD52) [24,27,28,32]. Although serum amylase and lipase are reasonable markers for rejection, the window for detecting and treating acute rejection is reasonably small.…”

The survival advantage of pancreas after kidney transplant

“…Also, the patients' cardiac status has essentially undergone a pre-PAK stress test by virtue of the kidney transplant operation, and therefore there is an increased assurance of cardiovascular fitness. [22][23][24][25][26][27][28][29][30][31] The depleting antibodies used include rabbit anti-thymocyte globulin 22,24,25,28,29,32 or alemtuzumab (anti-CD 52). 19 Historically, PAK transplants have been associated with inferior pancreas allograft survival compared with SPK transplants (in reports from 2003-2004, 78% vs 85% 1-year graft survival, P ≤ .0001), 20,21 which was attributed to increased immunologic pancreas graft loss in PAK recipients (in reports from 2003-2004, 5.2% vs 1.8% at 1 year, P ≤ .0001).…”

“…The current direction of the field is induction with T cell-depleting antibody with steroid withdrawal. [22][23][24][25][26][27][28][29][30][31] The depleting antibodies used include rabbit anti-thymocyte globulin 22,24,25,28,29,32 or alemtuzumab (anti-CD 52). 23,26,27,31 One of these studies was also calcineurin inhibitor free, using alemtuzumab and mycophenolate mofetil as maintenance immunosuppression, 26 and another used alemtuzumab induction with monotherapy tacrolimus maintenance.…”

Renal Transplantation

“…Human renal allograft transplantation centers frequently report a 1-year patient and kidney graft survival rate of 100% (Aoun et al 2007). Human renal allograft transplantation centers frequently report a 1-year patient and kidney graft survival rate of 100% (Aoun et al 2007).…”