Very early steroid withdrawal in simultaneous pancreas-kidney transplants.
BACKGROUND
Simultaneous pancreas-kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, early withdrawal of corticosteroids may be an important issue.


METHODS
A total of 24 consecutive patients with type 1 diabetes mellitus had been treated by SPK transplantation. All of them had a short induction therapy with anti-thymoglobulin (ATG) and steroids for only 4 days, association with CellCept and tacrolimus. The rate of acute rejection, graft and patient survival and side effects have been analysed.


RESULTS
Patient and kidney survival was 100% and the pancreas survival was 95.6% at 1 year. The rate of acute rejection of kidney and pancreas was 4.2% and 8.3% at 6 months, respectively. The mean serum creatinine was 98.9+/-19.6 micromol/l and the mean HbA1c concentration was 5.1%+/-0.5% at 6 months. Only four patients developed a cytomegalovirus primo-infection, associated in one case with pneumonia, whereas 75% of patients developed a bacterial infection. Because of the occurrence of leucopenia and/or diarrhoea, CellCept has been dramatically decreased in 33% of cases and required the re-introduction of steroids.


CONCLUSIONS
A short induction with ATG and steroids associated with a chronic therapy with CellCept and tacrolimus is safe and efficient in preventing acute renal rejection in SPK.
Aoun
Mabel
M
Nephrology Unit Le Kremlin Bicetre, INSERM U542, IFRNT, France.
Eschewege
Pascal
P
Hamoudi
Yacine
Y
Beaudreuil
Severine
S
Duranteau
Jacques
J
Cheisson
Gaelle
G
Noel
Christian
C
Benoit
Gerard
G
Charpentier
Bernard
B
Durrbach
Antoine
A
D000208:Acute Disease; D000328:Adult; D001323:Autoantibodies / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000379:methods*; D011355:Prodrugs; D011446:Prospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D001323:Autoantibodies; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011355:Prodrugs; C006606:anti-thyroglobulin; D009173:Mycophenolic Acid; D016559:Tacrolimus