A pilot study of immunosuppression minimization after pancreas-kidney transplantation utilizing thymoglobulin induction and sirolimus maintenance therapy.
OBJECTIVE
To determine outcomes utilizing thymoglobulin and sirolimus immunosuppression, with early steroid withdrawal in low-immune responder pancreas-kidney (SPK) recipients, and conversion from cyclosporine (CsA) to mycophenolic acid (MPA) in all recipients at 6 months posttransplantation.


METHODS
SPK recipients received thymoglobulin, sirolimus, and reduced-dose CsA immunosuppression. Low immune responders (non-African-Americans with a pretransplant PRA < 30%) were withdrawn from prednisone on posttransplant day 5 and high immune responders were continued on prednisone. All recipients were converted from CsA to MPA at 6 months posttransplantation. During conversion, recipient immune response was monitored by flow PRA and a T-cell stimulation assay (Cylex).


RESULTS
With a mean follow-up of 9 +/- 4 months, one pancreas was lost to pancreatitis, with no patient or kidney losses and no acute rejection episodes. All eight low immune responder patients were steroid-free at 9 +/- 5 months posttransplantation. Seven patients (five low and two high immune responders) with at least 6-month follow-up were converted from CsA to MPA. One high immune responder with a pretransplant PRA of 43% remained with a PRA of 53% +/- 2% postconversion. The second high immune responder had a pretransplant PRA of 34% and a postconversion PRA of 0%. The five low immune responders had a mean pretransplant PRA of 16% +/- 15% and a postconversion PRA of 0% (P < .01). The Cylex assay resulted in 67% low responsiveness for both high and low immune responders.


CONCLUSIONS
Thymoglobulin induction with sirolimus maintenance therapy permitted immunosuppression minimization in selected pancreas transplant recipients. Posttransplant evaluation revealed a diminished (regulated) immune response in six of seven patients.
Knight
R J
RJ
Division of Immunology and Organ Transplantation, University of Texas Medical School, 6431 Fannin Street, Houston, TX 77030, USA. Richard.j.knight@uth.tmc.edu
Kerman
R H
RH
McKissick
E
E
Lawless
A
A
Podder
H
H
Katz
S
S
Van Buren
C T
CT
Kahan
B D
BD
D000818:Animals; D000906:Antibodies / Q000097:blood; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D016035:Pancreas Transplantation / Q000276:immunology*; D010865:Pilot Projects; D011446:Prospective Studies; D011817:Rabbits; D020123:Sirolimus / Q000627:therapeutic use*; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome
D000906:Antibodies; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D020123:Sirolimus