Successful simultaneous islet-kidney transplantation using a steroid-free immunosuppression: two-year follow-up.
We report on the feasibility of a glucocorticoid-free immunosuppression (sirolimus, low-dose tacrolimus, and daclizumab) in simultaneous islet-kidney transplantation in nine patients with type 1 diabetes. There was one renal primary nonfunction. Renal function (n = 8) as assessed by creatinine and creatinine clearance over time was 103 +/- 6 micromol/L and 64 +/- 6 mL/min/1.73 m(2), respectively. Five out of six patients with >or= 2 islet transplantations became insulin independent. The mean HbA(1c) during the follow-up period for all patients after transplantation is 6.2 +/- 0.9% as compared with 8.7 +/- 1.9% prior to transplant. These results in patients with a median follow-up of 2.3 years suggest that kidney transplantation under a glucocorticoid-free immunosuppression is feasible, and that the rate of insulin independence of 80% can be achieved not only in patients with no or minimal diabetes complications, but also in patients with more advanced late complications and in conjunction with kidney transplantation.
Lehmann
Roger
R
Departments of Radiology and Visceral Surgery, University Hospital, CH-8091 Zurich, Switzerland. Roger.Lehmann@usz.ch
Weber
Markus
M
Berthold
Peter
P
Züllig
Richard
R
Pfammatter
Thomas
T
Moritz
Wolfgang
W
Mädler
Kathrin
K
Donath
Marc
M
Ambühl
Patrice
P
Demartines
Nicolas
N
Clavien And
Pierr-Alain
PA
Andreia Spinas
Giatgen
G
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D019540:Area Under Curve; D002096:C-Peptide / Q000097:blood / Q000737:chemistry; D003404:Creatinine / Q000378:metabolism; D000077561:Daclizumab; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007108:Immune Tolerance; D007074:Immunoglobulin G / Q000627:therapeutic use; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D007328:Insulin / Q000378:metabolism; D007515:Islets of Langerhans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D007668:Kidney / Q000378:metabolism / Q000502:physiology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism; D011487:Protein Conformation; D020123:Sirolimus / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D009927:Tissue and Organ Procurement; D019172:Transplantation Conditioning
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D002096:C-Peptide; D005938:Glucocorticoids; D006454:Hemoglobins; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007328:Insulin; D003404:Creatinine; D000077561:Daclizumab; D020123:Sirolimus; D016559:Tacrolimus