Immunosuppression in simultaneous pancreas-kidney transplantation: Progress to date

Raymond L. Heilman, Marek J. Mazur, Kunam Sudhakar Reddy

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with end-stage renal failure due to type 1 diabetes mellitus. With advances in surgical techniques and immunosuppression management, outcomes have improved, with current 1-and 10-year pancreas graft survival rates of 86 and 53, respectively. Induction therapy with either alemtuzumab or rabbit antithymocyte globulin (rATG) in combination with a calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF) or sirolimus appears to be safe and effective in the setting of rapid steroid withdrawal (RSW), with excellent graft survival and low rejection rates. There are no large randomized trials between alemtuzumab and rATG to determine whether one is better than the other. Anti-interleukin (IL)-2 receptor antibody induction and no induction in combination with a CNI, MMF or sirolimus, and prednisone have demonstrated excellent graft survival rates but are associated with a higher incidence of acute rejection. The efficacy of anti-IL-2 receptor antibodies or no induction in the setting of RSW is unproven. Both of the CNIs, ciclosporin and tacrolimus, are effective in preventing acute rejection in SPKT recipients; however, pancreas allograft survival may be better with tacrolimus. MMF is more effective than azathioprine in preventing acute rejection. Sirolimus appears to be effective in preventing acute rejection, but the combination of sirolimus with a CNI may accentuate the nephrotoxicity of the CNI. RSW with induction therapy is safe and effective in SPKT recipients, but longer follow-up data on outcomes are needed. Recent analysis of registry data shows that most transplant centres are using an induction agent followed by a combination of tacrolimus, MMF and corticosteroids in SPKT recipients.

Original languageEnglish (US)
Pages (from-to)793-804
Number of pages12
JournalDrugs
Volume70
Issue number7
DOIs
StatePublished - 2010

Fingerprint

Mycophenolic Acid
Pancreas Transplantation
Sirolimus
Kidney Transplantation
Immunosuppression
Tacrolimus
Graft Survival
Antilymphocyte Serum
Interleukin-2 Receptors
Steroids
Pancreas
Survival Rate
Rabbits
Antibodies
Azathioprine
Prednisone
Type 1 Diabetes Mellitus
Cyclosporine
Chronic Kidney Failure
Allografts

Keywords

  • Alemtuzumab, therapeutic use
  • Antithymocyte-globulin, therapeutic use
  • Basiliximab, therapeutic use
  • Ciclosporin, therapeutic use
  • Daclizumab, therapeutic use
  • Kidney-pancreas-transplant
  • Kidney-pancreas-transplant-rejection

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Immunosuppression in simultaneous pancreas-kidney transplantation : Progress to date. / Heilman, Raymond L.; Mazur, Marek J.; Reddy, Kunam Sudhakar.

In: Drugs, Vol. 70, No. 7, 2010, p. 793-804.

Research output: Contribution to journalArticle

Heilman, Raymond L. ; Mazur, Marek J. ; Reddy, Kunam Sudhakar. / Immunosuppression in simultaneous pancreas-kidney transplantation : Progress to date. In: Drugs. 2010 ; Vol. 70, No. 7. pp. 793-804.
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