Humar A, Parr E, Drangstveit M B, Kandaswamy R, Gruessner A C, Sutherland D E
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Clin Transplant. 2000 Feb;14(1):75-8. doi: 10.1034/j.1399-0012.2000.140114.x.
Numerous studies of steroid withdrawal have been carried out in kidney and liver transplant recipients, but only a few in pancreas transplant recipients. Yet, pancreas transplant recipients could have significant long-term benefits from steroid withdrawal.
We performed a retrospective analysis to determine the feasibility of steroid withdrawal in pancreas transplant recipients.
Of 360 recipients who underwent a pancreas transplant between January 1, 1994 and June 30, 1998, 14 attempted steroid withdrawal (12 simultaneous pancreas-kidney [SPK]; 2 pancreas transplant alone [PTA]). Reasons for steroid withdrawal were bone fractures (n = 3), psychiatric disorders (n = 2), severe acne (n = 1), recurrent infections (n = 4), and problems with hypercholesterolemia or hypertension (n = 4). All 14 were maintained on tacrolimus and mycophenolate mofetil (MMF) immunosuppression, except for 1 who was on tacrolimus and azathioprine (AZA). Of the 14 recipients, 11 had no episodes of acute rejection before steroid withdrawal. The remaining 3 had one or more acute rejection episodes. Of the 14 recipients, 10 (72%) currently remain off steroids (mean follow-up 18 months, range 5-51 months). However, 4 recipients have resumed steroids: 2 after an acute rejection episode (at 2 and 21 months post-withdrawal) and 2 because of leukopenia (WBC < 3000) and an inability to tolerate full-dose MMF. Steroid withdrawal was unsuccessful in both PTA recipients and in 2 of the 12 SPK recipients. All 14 recipients currently have a functioning pancreas graft. However, 1 of the SPK recipients, in whom steroid withdrawal failed, has developed chronic kidney rejection and is now back on hemodialysis awaiting a retransplant.
Steroid withdrawal is possible in up to 70% of pancreas transplant recipients. Further studies are necessary to define ideal candidates for steroid withdrawal. Based on the results of this analysis, we have launched a prospective, randomized trial of steroid withdrawal in pancreas transplant recipients.
在肾移植和肝移植受者中已开展了大量关于停用类固醇的研究，但在胰腺移植受者中开展的研究较少。然而，胰腺移植受者停用类固醇可能会获得显著的长期益处。
我们进行了一项回顾性分析，以确定胰腺移植受者停用类固醇的可行性。
在1994年1月1日至1998年6月30日期间接受胰腺移植的360例受者中，14例尝试停用类固醇（12例胰肾联合移植[SPK]；2例单纯胰腺移植[PTA]）。停用类固醇的原因包括骨折（n = 3）、精神障碍（n = 2）、重度痤疮（n = 1）、反复感染（n = 4）以及高胆固醇血症或高血压问题（n = 4）。除1例使用他克莫司和硫唑嘌呤（AZA）外，其余14例均维持使用他克莫司和霉酚酸酯（MMF）进行免疫抑制。在这14例受者中，11例在停用类固醇前无急性排斥反应发作。其余3例有一次或多次急性排斥反应发作。在这14例受者中，10例（72%）目前仍未使用类固醇（平均随访18个月，范围5 - 51个月）。然而，4例受者恢复使用类固醇：2例在急性排斥反应发作后（停用后2个月和21个月），2例因白细胞减少（白细胞计数<3000）且无法耐受全剂量MMF。PTA受者以及12例SPK受者中的2例停用类固醇未成功。所有14例受者目前胰腺移植均功能良好。然而，1例停用类固醇失败的SPK受者已发生慢性肾排斥反应，现重新接受血液透析，等待再次移植。
高达70%的胰腺移植受者有可能停用类固醇。需要进一步研究以确定停用类固醇的理想候选者。基于本分析结果，我们已开展一项关于胰腺移植受者停用类固醇的前瞻性随机试验。
