Rescue therapy with tacrolimus in simultaneous pancreas/kidney transplantation

Abstract

Tacrolimus has been effective both in primary and rescue therapy following steroid and OKT3-resistant acute rejection in liver and kidney transplantation. Due to the effects of tacrolimus on glucose metabolism, there has been concern about its use in simultaneous pancreadkidney transplantation. We report on the results of six patients (three female, three male, age 35.2 k 7.3 years) converted from cyclosporin A to tacrolimus following simultaneous pancreadkidney transplantation in steroid-resistant acute rejection. Tacrolimus was induced 2.8 f 1.7 months (range 1-4.8 months) after transplantation; follow-up was 3-18 months. Following conversion, creatinine levels declined in all patients [3.5 k 1.2 mg/dl before conversion, 3.0 f 1.9 mg/dl ( n = 6) at three months, 1.4 k 0.1 mg/ dl at 1 year ( n = 3)]. Before conversion, fasting blood glucose levels averaged 154 f 33 mg/dl, with three patients receiving insulin. Three months later no patient required insulin, the mean glucose level being 107 i-23 mg/dl ( n = 6); at 1 year it was 92 f 9 mg/dl (n = 3). One patient lost his pancreatic graft after 4 months due to a mycotic aneurysm. We conclude that conversion to tacrolimus is a safe and effective treatment in cases of steroid-resistant rejections following pancreas/ kidney transplantation.

Immunologic Aspects of Transplant Management: Pharmacotherapy and Rejection

“…A large, multicenter, nonrandomized, case-matching analysis [91] showed FKbased immunosuppression to have a lower rate of rejection, particularly in solitary pancreas transplantation, which typically has a higher rate of rejection than simultaneous kidney-pancreas transplant. This multicenter study and other smaller studies [92,93] have demonstrated that FK can be used to treat rejection in place of steroids or ALA. Several of these studies have suggested that FK may have slightly more diabetogenicity than CsA in kidney-pancreas transplantation. No doubt this will be clarified as regimens are perfected and larger trials are done.…”

Immunologic Aspects of Transplant Management: Pharmacotherapy and Rejection

“…A large, multicenter, nonrandomized, case‐matching analysis [91] showed FK‐based immunosuppression to have a lower rate of rejection, particularly in solitary pancreas transplantation, which typically has a higher rate of rejection than simultaneous kidney–pancreas transplant. This multicenter study and other smaller studies [92,93] have demonstrated that FK can be used to treat rejection in place of steroids or ALA. Several of these studies have suggested that FK may have slightly more diabetogenicity than CsA in kidney–pancreas transplantation. No doubt this will be clarified as regimens are perfected and larger trials are done.…”

Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) guidelines on kidney transplantation: a European Renal Best Practice (ERBP) position statement

“…So, this line of treatment is also endorsed [17]. It may, however, be mentioned that a switch to tacrolimus is also an option in the treatment of humoral and acute cellular rejection [18][19][20][21].…”