title: Tailored immunosuppression and steroid withdrawal in pancreas-kidney transplantation.
abstract: BACKGROUND
  Recent improvements in simultaneous pancreas-kidney transplantation (SPK) and the striking decrease in acute rejection lead us to focus on the effects of long-term immunosuppression.
  
  
  OBJECTIVE
  Evaluation of a policy of steroid withdrawal and tailored immunosuppression in pancreas-kidney patients treated in a single center.
  
  
  METHODS
  review of the clinical charts in 9 SPK recipients (male/female = 5/4, median age 41 years, median follow-up 42 months), by the same operator, under supervision of the two usual caregivers. Therapeutic protocols. Induction phase: all patients received mycophenolate mophetil (starting dose: 2 grams), tacrolimus and steroids, 8 received Simulect, 1 received thymoglobulins. Maintenance therapy was slowly reduced, with the goal of steroid withdrawal.
  
  
  RESULTS
  The therapeutic adjustments were mainly determined by two almost opposing elements: 1. Rapid adjustments in the case of side-effects (gastrointestinal problems, infections and neoplasia); 2. Slow tapering off in the case of good organ function. On the other hand, a switch to cyclosporine A and to rapamycine was considered in the case of chronic organ malfunction. By these means, over a median of 42 months follow-up, steroid withdrawal was slowly obtained in 6/9 patients (at a median time of 25 months).
  
  
  CONCLUSIONS
  Within the limits of this small-scale study, a tailored immunosuppressive policy allows at least some "positively selected" patients to reach the "dream" of steroid withdrawal after SPK.
authors.affiliation: Department of Internal Medicine, University of Turin, Corso Bramante 86-88, 10126 Torino, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Rossetti
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Manuel
authors.initials: M
authors.lastname: Burdese
authors.forename: Cesare
authors.initials: C
authors.lastname: Guarena
authors.forename: Roberta
authors.initials: R
authors.lastname: Giraudi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Mezza
authors.forename: Valentina
authors.initials: V
authors.lastname: Consiglio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Soragna
authors.forename: Maria
authors.initials: M
authors.lastname: Messina
authors.forename: Giuseppe P
authors.initials: GP
authors.lastname: Segoloni