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  • Title: Advances in immunosuppression for pancreas transplantation.
    Author: Singh RP, Stratta RJ.
    Journal: Curr Opin Organ Transplant; 2008 Feb; 13(1):79-84. PubMed ID: 18660711.
    Abstract:
    PURPOSE OF REVIEW: A review of current literature was performed to identify trends and evaluate outcomes with regard to clinical immunosuppression in pancreas transplantation. RECENT FINDINGS: Through 2006, over 20 000 pancreas transplantations were performed in the US. Since 2000, the 1-year patient survival rates for the three pancreas transplantation categories--simultaneous pancreas-kidney, sequential pancreas after kidney, and pancreas alone--were 95-97% and the 1-year pancreas graft survival (complete insulin independence) rates were 85%, 78%, and 77%, respectively. One-year rates of rejection have steadily decreased and are currently in the 10-20% range depending on case mix and immunosuppressive regimen. At present, 88% of recipients receive antibody induction, 65% receive maintenance therapy with the tacrolimus/mycophenolate mofetil combination, and 40-50% undergo corticosteroid withdrawal without adverse consequences. Limited data with tacrolimus/sirolimus reveal excellent short-term outcomes, whereas initial attempts with calcineurin inhibitor avoidance or minimization are less promising. SUMMARY: Antibody induction and either tacrolimus/mycophenolate mofetil or tacrolimus/sirolimus maintenance therapy with steroid withdrawal have become the mainstay of contemporary immunosuppression in clinical pancreas transplantation. The development of a nonnephrotoxic, nondiabetogenic, and nongastrointestinal toxic regimen, however, is highly desirable to improve outcomes and quality of life in recipients.
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