Long-term results of protocol kidney biopsy directing steroid withdrawal in simultaneous pancreas-kidney transplant patients

Abstract

We sought to determine whether protocol biopsies could be used to guide treatment and improve outcomes in simultaneous pancreas-kidney (SPK) patients. Methods: Between 2004 and 2013, protocol biopsies were performed on SPK patients at 3-6 months and one year post-transplant. Maintenance immunosuppression consisted of a calcineurin inhibitor, anti-proliferative agent, and corticosteroid. Corticosteroid was withdrawn in negative early biopsies, maintained in subclinical/borderline biopsies, and increased if Banff IB or greater rejection was identified. Endpoints included presence of interstitial fibrosis and tubular atrophy on biopsy at one year (IF/TA), rejection episodes, renal and pancreas function at five years' followup.

Effectiveness of T cell–mediated rejection therapy: A systematic review and meta-analysis

“…From 2875 unique citations identified through our systematic literature search, 12 studies 8 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 (involving 1255 participants) met our eligibility criteria (Figure 1 ). The characteristics of these studies are summarized in Table 1 .…”

“…The characteristics of these studies are summarized in Table 1 . Half of the studies ( n = 6) were from the United States of America (USA), 24 , 26 , 27 , 28 , 30 , 33 two studies were from Canada, 29 , 34 while one study each was from Australia, 31 France, 8 Poland, 32 and Taiwan. 25 There was one randomized controlled trial (RCT), 24 two multicenter prospective observational cohorts, 27 , 29 five single center prospective observational cohorts, 8 , 26 , 28 , 30 , 32 and four single‐center retrospective cohorts.…”

“… 25 There was one randomized controlled trial (RCT), 24 two multicenter prospective observational cohorts, 27 , 29 five single center prospective observational cohorts, 8 , 26 , 28 , 30 , 32 and four single‐center retrospective cohorts. 25 , 31 , 33 , 34 Two studies reported receiving industry funding. 24 , 27 All studies involved both sexes (varying proportions) with 10 adult and two pediatric studies.…”

“…Patient population description differed slightly across the studies, with patients in three studies receiving kidney/pancreas transplants. 30 , 31 , 34 The proportion of deceased donor kidney transplants ranged from 31 to 82% in 10 studies and two studies had 100% deceased donors 32 , 34 (Table S2 ).…”

“…The characteristics of these studies are summarized in Table 1. Half of the studies (n = 6) were from the United States of America (USA), 24,[26][27][28]30,33 two studies were from Canada, 29,34 while one study each was from Australia, 31 France, 8…”