Hanaway M J, Roy-Chaudhury P, Buell J F, Thomas M, Munda R, Alloway R R, Ellison V, Rudich S M, Fisher L, Woodle E S
University of Cincinnati, Cincinnati, Ohio 45249, USA.
Transplant Proc. 2005 Mar;37(2):1287-8. doi: 10.1016/j.transproceed.2004.12.072.
Early corticosteroid withdrawal has recently been shown to be possible in recipients of simultaneous pancreas kidney transplants; however, its feasibility in solitary pancreas recipients has not been documented. In the present study, we provide evidence that early withdrawal can be achieved in pancreas as well as pancreas-kidney recipients.
Twenty type I diabetics underwent 13 pancreas-kidney transplants and 7 pancreas-only transplants with early withdrawal (methylprednisone 6-day taper). Additional immunosuppression consisted of tacrolimus, mycophenolate mofetil, and thymoglobulin induction (five doses).
Transplants included 13 pancreas-kidney, 6 pancreas after kidney transplant, and 1 pancreas after islet transplant. Overall mean follow-up was 7.3 months. One episode of pancreas transplant rejection after pancreas-only transplant was detected on protocol biopsy without biochemical abnormalities. One renal allograft rejection occurred 65 days posttransplant in a pancreas-kidney recipient and was graded as a Banff IA rejection. A single pancreas graft loss occurred due to thrombosis 6 days after pancreas-kidney transplantation.
These results indicate that relatively short thymoglobulin induction (five doses) with tacrolimus and mycophenolate mofetil can allow early withdrawal in both pancreas-kidney and pancreas-only transplant recipients.
近期研究表明，同期胰肾联合移植受者可早期停用皮质类固醇；然而，其在单纯胰腺移植受者中的可行性尚无文献记载。在本研究中，我们提供证据表明，胰腺移植受者以及胰肾联合移植受者均可实现早期停药。
20例I型糖尿病患者接受了13例胰肾联合移植和7例单纯胰腺移植，并早期停药（甲泼尼龙6天递减）。额外的免疫抑制包括他克莫司、霉酚酸酯和胸腺球蛋白诱导（五剂）。
移植包括13例胰肾联合移植、6例肾移植后胰腺移植和1例胰岛移植后胰腺移植。总体平均随访时间为7.3个月。在方案活检中检测到1例单纯胰腺移植后胰腺移植排斥反应，无生化异常。1例胰肾联合移植受者在移植后65天发生1次肾移植排斥反应，分级为班夫IA级排斥反应。1例胰肾联合移植后6天因血栓形成导致单一胰腺移植失败。
这些结果表明，使用他克莫司和霉酚酸酯进行相对短期的胸腺球蛋白诱导（五剂）可使胰肾联合移植受者和单纯胰腺移植受者早期停药。
