Federal University of São Paulo, SP, Brazil.
Expert Opin Drug Metab Toxicol. 2012 Dec;8(12):1531-48. doi: 10.1517/17425255.2012.724058. Epub 2012 Sep 17.
Pancreas-kidney transplant is an effective treatment for patients with insulin-dependent dabetes and chronic renal failure. Reduction in technical failure loss and early acute rejection rates contributed to prolong pancreas graft survival. However, drug toxicity affects negatively both short- and long-term follow-ups.
This article reviews the existing literature and knowledge of the immunosuppressive drugs that are frequently used in pancreas transplant, including calcineurin inhibitors, sirolimus, corticosteroids, and mycophenolate. The article also discusses the short- and long-term adverse effects of these drugs. The article also reports and discusses the most relevant in vitro studies, providing additional information to in vivo findings. Some clinically relevant drug interactions with immunosuppressive drugs are also highlighted. Over- and underimmunosuppression effects will not be addressed.
Immunosuppressive regimen after pancreas transplant is very effective and contributed to pancreas allograft survival. However, they present several side effects that are potentiated when drugs are combined. Modifiable and non-modifiable risk factors can aggravate metabolic and toxicological effects of immunosuppressive drugs. It is important to critically analyze the results of clinical studies and investigate new immunosuppressive drugs and/or novel drug combinations. It is equally important to comprehend and interpret experimental data. Therefore, minimization of side effects, based on safe approaches, can prolong pancreas allograft survival.
胰腺-肾移植是治疗胰岛素依赖型糖尿病和慢性肾衰竭患者的有效方法。降低技术失败率和早期急性排斥反应率有助于延长胰腺移植物的存活时间。然而，药物毒性会对短期和长期随访产生负面影响。
本文回顾了常用于胰腺移植的免疫抑制剂药物的现有文献和知识，包括钙调神经磷酸酶抑制剂、西罗莫司、皮质类固醇和霉酚酸酯。本文还讨论了这些药物的短期和长期不良反应。文章还报告和讨论了最相关的体外研究，为体内发现提供了额外的信息。还强调了一些与免疫抑制剂药物相关的临床相关药物相互作用。本文不讨论过免疫和欠免疫的影响。
胰腺移植后的免疫抑制方案非常有效，有助于胰腺同种异体移植物的存活。然而，当药物联合使用时，它们会产生多种副作用。可改变和不可改变的危险因素会加重免疫抑制剂药物的代谢和毒理学作用。重要的是要批判性地分析临床研究的结果，并研究新的免疫抑制剂药物和/或新型药物组合。同样重要的是要理解和解释实验数据。因此，基于安全方法的最小化副作用可以延长胰腺同种异体移植物的存活时间。
