Tailored Immunosuppression and Steroid Withdrawal in Pancreas-Kidney Transplantation

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Abstract
The Review of Diabetic Studies,2004,1,3,129-136.
Published:November 2004
Type:Review Article
Authors:
Author(s) affiliations:

Maura Rossetti, Giorgina B. Piccoli, Manuel Burdese, Cesare Guarena, Roberta Giraudi, Elisabetta Mezza, Valentina Consiglio, Giorgio Soragna, Maria Messina and Giuseppe P. Segoloni

Chair of Nephrology, Department of Internal Medicine, University of Turin, Corso Bramante 86-88, 10126 Torino, Italy.

Abstract:

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). Conclusion: Within the limits of this smallscale study, a tailored immunosuppressive policy allows at least some “positively selected” patients to reach the “dream” of steroid withdrawal after SPK.