A retrospective study of steroid elimination in simultaneous pancreas and preemptive kidney transplant (Sppre-Ktx) recipients.
OBJECTIVE
The feasibility and timing of corticosteroid elimination and its impact on lipid metabolism in simultaneous pancreas and preemptive kidney transplantation were examined.


METHODS
A retrospective study was conducted on 14 recipients of pancreas and preemptive kidney grafts transplanted form April 2003 to March 2004. All recipients received ATG induction. Tacrolimus (Tac) was administered according to trough concentration 8-15 ng/ml. Mycophenolate mofetil (MMF) was administered at doses of 2 g per day with subsequent dosage adjustment based on tolerability. All recipients received corticosteroids with subsequent dose tapering. Total cholesterol and triglyceride levels before transplantation and after steroid withdrawal were assessed.


RESULTS
One year recipient survival rate was 100%. Cumulative one year panaceas and kidney survival rates were: 85% and 100%, respectively. After transplantation of fasting glycemia and HbAIC were normalized. Serum creatinine decreased from 4.35 +/- 1.61 mg/dl before transplantation to 1.1 + 0.25 mg/dl after surgery (p < 0.05). Corticosteroids were eliminated between the 2nd and 16th month (mean 6 months) after transplantation. Cholesterol and triglyceride levels were wiyhin normal range, in addition significantly decreased after transplantation and steroid withdrawal, from 194.5 +/- 35.6 mg/dl to 162.4 +/- 36.8 mg/dl and 142.5 +/- 65 94.8 +/- 42.5 mg/dl, respectively (p < 0.05).


CONCLUSIONS
It is possible to eliminate steroids 6 months after transplantation using immunossupression based on MMF and Tac. Withdrawal of steroids could be partially contributed to the normalization of lipid metabolism.
Grochowiecki
Tadeusz
T
Department of General, Vascular and Transplant Surgery, The Medical University of Warsaw, Poland. trgroch@amwaw.edu.pl
Wyzgał
Janusz
J
Gałazka
Zbigniew
Z
Nazarewski
Sławomir
S
Grygiel
Katarzyna
K
Pietrasik
Kamil
K
Sańko-Resmer
Joanna
J
Paczek
Leszek
L
Szmidt
Jacek
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003928:Diabetic Nephropathies / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use; D013997:Time Factors; D014184:Transplantation, Homologous
D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus