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Steroid withdrawal in pancreas transplant recipients
Author(s) -
Humar Abhinav,
Parr Elizabeth,
Drangstveit Mary Beth,
Kandaswamy Raja,
Gruessner Angelika C,
Sutherland David Er
Publication year - 2000
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2000.140114.x
Subject(s) - medicine , tacrolimus , immunosuppression , azathioprine , leukopenia , pancreas , gastroenterology , pancreas transplantation , surgery , transplantation , kidney transplantation , chemotherapy , disease
Background. Numerous studies of steroid withdrawal have been carried out in kidney and liver transplant recipients, but only a few in pancreas transplant recipients. Yet, pancreas transplant recipients could have significant long‐term benefits from steroid withdrawal.Methods. We performed a retrospective analysis to determine the feasibility of steroid withdrawal in pancreas transplant recipients.Results. Of 360 recipients who underwent a pancreas transplant between January 1, 1994 and June 30, 1998, 14 attempted steroid withdrawal (12 simultaneous pancreas–kidney [SPK]; 2 pancreas transplant alone [PTA]). Reasons for steroid withdrawal were bone fractures (n=3), psychiatric disorders (n=2), severe acne (n=1), recurrent infections (n=4), and problems with hypercholesterolemia or hypertension (n=4). All 14 were maintained on tacrolimus and mycophenolate mofetil (MMF) immunosuppression, except for 1 who was on tacrolimus and azathioprine (AZA). Of the 14 recipients, 11 had no episodes of acute rejection before steroid withdrawal. The remaining 3 had one or more acute rejection episodes.Of the 14 recipients, 10 (72%) currently remain off steroids (mean follow‐up 18 months, range 5–51 months). However, 4 recipients have resumed steroids: 2 after an acute rejection episode (at 2 and 21 months post‐withdrawal) and 2 because of leukopenia (WBC<3 000) and an inability to tolerate full‐dose MMF. Steroid withdrawal was unsuccessful in both PTA recipients and in 2 of the 12 SPK recipients. All 14 recipients currently have a functioning pancreas graft. However, 1 of the SPK recipients, in whom steroid withdrawal failed, has developed chronic kidney rejection and is now back on hemodialysis awaiting a retransplant.Conclusion. Steroid withdrawal is possible in up to 70% of pancreas transplant recipients. Further studies are necessary to define ideal candidates for steroid withdrawal. Based on the results of this analysis, we have launched a prospective, randomized trial of steroid withdrawal in pancreas transplant recipients.