Impact of steroid withdrawal on metabolic parameters in a series of 112 enteric/systemic-drained pancreatic transplants.
BACKGROUND
New immunosuppressive protocols and advanced surgical techniques have brought major improvements in pancreas transplantation outcomes. Steroid withdrawal might have a beneficial long-term effect on metabolic parameters.


METHODS
We retrospectively analyzed 112 enteric-drained pancreas transplants (PTx) performed between March 1997 and October 2001. Prophylactic imunosuppression consisted of ATG induction, tacrolimus, MMF, and steroids.


RESULTS
Actuarial patient, pancreas, and kidney graft survivals at 1 year were 96.4%, 86.7%, and 95.3%, respectively. The 5-year pancreatic graft survival was 77%. In addition to four patients who died with functioning grafts, eight grafts were lost due to intraabdominal infection; ten due to rejection; and the remaining three, due to other complications. One-year follow-up was available for 89 patients, Including 22 (25%) withdrawn from steroids. Significantly lower median serum cholesterol values were measured among patients off steroids (158 mg/dL [range 135 to 231 mg/dL] versus 188 mg/dL [range 91 to 278 mg/dl]; P = .005). In contrast, the difference in triglycerides did not reach statistical significance; that is, at last follow-up, at a median of 41.3 months posttransplant, 64 patients (70% of the available study population) were off steroids. Cessation of steroids resulted in significantly lower cholesterol (median 176 mg/dL [range 101 to 229 mg/dL] versus 196 mg/dL [range 107 to 339 mg/dL]; P = .047) and triglyceride values (median 74 mg/dL [range 34 to 299 mg/dL] versus 98 mg/dL [range 47 to 565 mg/dL]; P = .008), but had no impact on rejection rate, serum creatinine and urea, HbA(1c), or fasting blood glucose levels.


CONCLUSIONS
Steroid withdrawal after pancreatic transplantation can be performed in the majority of cases without risking an immunologic complication, but it seems to be associated also with the benefit of improved lipid metabolism.
Mark
W
W
Department of General Surgery, Innsbruck University Hospital, Innsbruck, Austria.
Berger
N
N
Lechleitner
M
M
Rosenkranz
A
A
Margreiter
R
R
Steurer
W
W
Bonatti
H
H
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D004322:Drainage; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods* / Q000502:physiology; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000379:methods* / Q000502:physiology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D013256:Steroids; D014280:Triglycerides; D002784:Cholesterol; D011239:Prednisolone; D003404:Creatinine; D009173:Mycophenolic Acid