Impact of a sirolimus/tacrolimus-based immunosuppressive regimen on kidney function after islet transplantation.
OBJECTIVE
Islet transplantation is gaining recognition as a therapeutic option for selected diabetic patients. The immunosuppressive regimen based on sirolimus/low-dose tacrolimus is considered a major breakthrough that allowed considerable improvement in graft survival. A high incidence of side effects associated with such a regimen has been reported in the literature, but this immunosuppressive protocol is generally considered safe or even protective to the kidney. Herein, we analyze the impact of the sirolimus/low-dose tacrolimus-based protocol on kidney function.


METHODS
Five islet-after-kidney and 5 islet-transplant-alone patients were enrolled and followed up. Renal function was assessed by the periodic measurement of serum creatinine and by the presence of albuminuria. Metabolic control markers and graft function were followed, as well as immunosuppressive whole blood trough levels.


RESULTS
Kidney function significantly decreased in 6 of 10 patients. Neither metabolic markers nor immunosuppressive drugs levels were significantly associated with the decreased kidney function.


CONCLUSIONS
Although a specific etiology was not identified, subsets of patients presented a higher risk for decrease of kidney function. The presence of low creatinine clearance, albuminuria, and long-established kidney graft were associated with poorer outcomes.
Andres
A
A
Cell Isolation and Transplantation Center, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Toso
C
C
Morel
P
P
Demuylder-Mischler
S
S
Bosco
D
D
Baertschiger
R
R
Pernin
N
N
Bucher
P
P
Majno
P E
PE
Bühler
L H
LH
Berney
T
T
D003404:Creatinine / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000601:surgery*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000276:immunology* / Q000379:methods / Q000502:physiology; D007677:Kidney Function Tests; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; D003404:Creatinine; D020123:Sirolimus; D016559:Tacrolimus