Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients

Montero, Núria; Webster, Angela C; Royuela, Ana; Zamora, Javier; Crespo, Marta; Pascual, Julio

doi:10.1002/14651858.cd007669.pub2

Cited by 26 publications

(25 citation statements)

References 49 publications

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“…Each of these is a potential obstacle after SPK [ 23 ]. A recent Cochran review evaluated steroid avoidance and steroid withdrawal protocols in pancreas transplant recipients [ 24 ]. The authors concluded there is insufficient evidence to support steroid avoidance/withdrawal (both early and late) in available studies of pancreas transplantation, most of which involved SPKs.…”

Section: Advances In Immunosuppressionmentioning

confidence: 99%

Simultaneous pancreas and kidney transplantation

Redfield¹,

Scalea²,

Odorico³

2015

Current Opinion in Organ Transplantation

105

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Purpose of reviewImportant trends are being observed in pancreas transplantation in the USA. We will describe recent trends in simultaneous pancreas kidney (SPK) transplantation related to immunosuppression, treatment of rejection, and transplantation for patients of advanced age and C-peptide positive diabetes.Recent findingsRates of pancreas transplantation have declined, despite improved pancreatic graft outcomes. Regarding immunosuppression, trends in SPK transplantation include T-cell depletion induction therapy, waning mammalian target of rapamycin inhibitor use and steroid use in greater than 50% of pancreas transplant recipients with few patients undergoing late steroid weaning. Rejection of the pancreas may be discordant with the kidney after SPK and there is a greater appreciation of antibody-mediated rejection of the pancreas allograft. De-novo donor-specific antibody without graft dysfunction remains an active area of study, and the treatment for this condition is unclear. SPKs are being performed with greater frequency in type 2 diabetes mellitus patients and in patients of advanced age, with exemplary results.SummaryThe current state of the art in SPK transplantation is yielding superb and improving results.

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Section: Advances In Immunosuppressionmentioning

confidence: 99%

Simultaneous pancreas and kidney transplantation

Redfield¹,

Scalea²,

Odorico³

2015

Current Opinion in Organ Transplantation

105

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“…In comparison with registry data, this represents quite a low number. 21 However, it did not unnecessarily increase the rejection rate, as reported by other authors, 22 and may even have prevented some of the undesirable metabolic effects attributed to sirolimus therapy. 17,23 Throughout the study, tacrolimus and sirolimus dose were quite stable with trough levels, usually not exceeding 10 ng/mL.…”

Section: Discussionmentioning

confidence: 58%

Sirolimus vs mycophenolate mofetil (MMF) in primary combined pancreas and kidney transplantation. Results of a long-term prospective randomized study

Girman

Lipar

Kočík

et al. 2020

American Journal of Transplantation

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The study was intended to compare pancreas graft survival rates in two groups of pancreas and kidney transplant recipients prospectively randomized to treatment either with sirolimus or MMF. From 2002 to 2013, 238 type 1 diabetic recipients with end‐stage kidney disease were randomized 1:1 to sirolimus or MMF treatment. Noncensored pancreas survival at 5 years was 76.4 and 71.6% for sirolimus and MMF groups, respectively (P > .05). Death‐censored pancreas survival was better in the sirolimus group (P = .037). After removal of early graft losses pancreas survival did not differ between groups (MMF 83.1% vs sirolimus 91.6%, P = .11). Nonsignificantly more grafts were lost due to rejection in the MMF group (10 vs 5; P = .19). Cumulative patient 5‐year survival was 96% in the MMF group and 91% in the sirolimus group (P > .05). Five‐year cumulative noncensored kidney graft survival rates did not statistically differ (85.6% in the sirolimus group and 88.8% in MMF group). Recipients treated with MMF had significantly more episodes of gastrointestinal bleeding (7 vs 0, P = .007). More recipients in the sirolimus group required corrective surgery due to incisional hernias (21 vs 12, P = .019). ClinicalTrials No.: NCT 03582878.

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“…‹mmünosüpresif tedavide sıklıkla steroid kullanılmaktadır ve bu tedavinin di¤er tedavi seçenekleri ile de¤itirilmesi gereklili¤i tam olarak açık de¤ildir. [10] Di¤er yandan da kullanılan immünosüpresif tedaviye ba¤lı oluabilecek diyabet varlı¤ı da di¤er bir sorundur.…”

Section: Pankreas Nakl‹ End‹kasyonlarıunclassified

Pancreas transplantation

Güçlü¹

2016

FNG & Bilim Tıp Transplantasyon Dergisi

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Destruction and lymphocyte infiltration of insulin secreting beta cells are observed in the pathogenesis of type 1 diabetes mellitus. As a result of this, it is challenging to control blood glucose level due to decreased insulin secretion. In 1966, W.D. Kelly achieved success in a type 1 diabetic patient with pancreas transplantation at Minnesota University. At the same university, application procedures were determined in 1978. In 1980, the requirement of new surgical techniques and immunosuppressive therapy was discovered. In recent years, prognosis of pancreas transplantation has improved and a decrease in long-term risks is observed. One year after transplantation, 95% of cases survive and 80% to 85% of pancreatic functions are preserved.

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Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients

Cited by 26 publications

References 49 publications

Simultaneous pancreas and kidney transplantation

Simultaneous pancreas and kidney transplantation

Sirolimus vs mycophenolate mofetil (MMF) in primary combined pancreas and kidney transplantation. Results of a long-term prospective randomized study

Pancreas transplantation

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