Vessal Ghazal, Wiland Anne M, Philosophe Benjamin, Fink Jeffrey C, Weir Matthew R, Klassen David K
School of Pharmacy, University of Maryland, Baltimore, MD, USA.
Clin Transplant. 2007 Jul-Aug;21(4):491-7. doi: 10.1111/j.1399-0012.2007.00675.x.
Although steroid withdrawal in simultaneous kidney pancreas transplantation has been shown to be feasible, the results of early steroid withdrawal in immunologically solitary pancreas transplantation are not well known. This study evaluated an early steroid withdrawal protocol in this group. The results of steroid withdrawal at 21 d post-transplant in solitary pancreas transplant recipients was compared with a control group consisting of solitary pancreas transplant recipients maintained on steroids (MG). Additional immunosuppression consisted of rabbit anti-thymocyte globulin induction followed by tacrolimus and mycophenolate mofetil in both groups. The withdrawal group (WG, n = 22) consisted of 11 pancreas transplant alone (PTA), six pancreas after kidney (PAK), and five simultaneous cadaveric pancreas living kidney (SPLK) recipients. The steroid maintenance group (MG, n = 32) consisted of 8 PTA, 11 PAK, and 13 SPLK recipients. Recipient and donor demographic characteristics were similar. Seventy eight percent of MG patients had infection-related complications in the first year compared with 50% of the WG patients (p = 0.04). The one-yr rejection, pancreas graft, and patient survival rates were 27.3% 95.5%, and 100% in the WG, and 37.5%, 81.3%, and 93.8% in the MG respectively and not significantly different. We conclude that early corticosteroid withdrawal in isolated pancreas transplantation results in fewer infections and can be achieved without an increased risk of rejection or graft loss over the first year.
尽管已证明在同期肾胰腺移植中停用类固醇是可行的，但在免疫孤立胰腺移植中早期停用类固醇的结果尚不清楚。本研究评估了该组中的早期类固醇撤药方案。将孤立胰腺移植受者移植后21天停用类固醇的结果与由维持使用类固醇的孤立胰腺移植受者组成的对照组（MG组）进行比较。两组的额外免疫抑制均包括兔抗胸腺细胞球蛋白诱导，随后使用他克莫司和霉酚酸酯。撤药组（WG组，n = 22）包括11名单纯胰腺移植（PTA）受者、6名肾后胰腺（PAK）受者和5名同期尸体胰腺活体肾（SPLK）受者。类固醇维持组（MG组，n = 32）包括8名PTA受者、11名PAK受者和13名SPLK受者。受者和供者的人口统计学特征相似。MG组78%的患者在第一年出现感染相关并发症，而WG组为50%（p = 0.04）。WG组1年时的排斥反应、胰腺移植物和患者生存率分别为27.3%、95.5%和100%，MG组分别为37.5%、81.3%和93.8%，差异无统计学意义。我们得出结论，在孤立胰腺移植中早期停用皮质类固醇可减少感染，并且在第一年不会增加排斥反应或移植物丢失的风险。
