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01.05.2010 | Leading Article

Immunosuppression in Simultaneous Pancreas-Kidney Transplantation

Progress to Date

verfasst von: Dr Raymond L. Heilman, Marek J. Mazur, K. Sudhakar Reddy

Erschienen in: Drugs | Ausgabe 7/2010

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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.

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Titel: Immunosuppression in Simultaneous Pancreas-Kidney Transplantation
Progress to Date
verfasst von: Dr Raymond L. Heilman
Marek J. Mazur
K. Sudhakar Reddy
Publikationsdatum: 01.05.2010
Verlag: Springer International Publishing
Erschienen in: Drugs / Ausgabe 7/2010
Print ISSN: 0012-6667
Elektronische ISSN: 1179-1950
DOI: https://doi.org/10.2165/11535430-000000000-00000

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Immunosuppression in Simultaneous Pancreas-Kidney Transplantation

Progress to Date

Abstract

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

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