The case for pancreas after kidney transplantation
: Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The...
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| Veröffentlicht in: | Clinical transplantation 2009-08, Vol.23 (4), p.447-453 |
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| container_title | Clinical transplantation |
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| creator | Fridell, Jonathan A. Mangus, Richard S. Hollinger, Edward F. Taber, Tim E. Goble, Michelle L. Mohler, Elaine Milgrom, Martin L. Powelson, John A. |
| description | : Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti‐thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One‐yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus‐based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor. |
| doi_str_mv | 10.1111/j.1399-0012.2009.00996.x |
| format | Article |
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Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti‐thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One‐yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus‐based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/j.1399-0012.2009.00996.x</identifier><identifier>PMID: 19453642</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Biological and medical sciences ; Cadaver ; Diabetic Nephropathies - surgery ; Drug Therapy, Combination ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Graft Survival ; Humans ; immunosuppression ; Immunosuppressive Agents - therapeutic use ; Kaplan-Meier Estimate ; Kidney Transplantation ; Living Donors ; Male ; Medical sciences ; Middle Aged ; pancreas after kidney transplantation ; Pancreas Transplantation ; rabbit anti-thymocyte globulin ; Retrospective Studies ; simultaneous kidney and pancreas transplantation ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; survival ; Tissue and Organ Procurement - standards ; Tissue, organ and graft immunology ; transplant outcomes ; Waiting Lists</subject><ispartof>Clinical transplantation, 2009-08, Vol.23 (4), p.447-453</ispartof><rights>2009 John Wiley & Sons A/S</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4346-4dafa919df71fb3ac698c3f6c6ad4a7f95291fa620d36bf05c94420a01616b3</citedby><cites>FETCH-LOGICAL-c4346-4dafa919df71fb3ac698c3f6c6ad4a7f95291fa620d36bf05c94420a01616b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-0012.2009.00996.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-0012.2009.00996.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21825187$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19453642$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fridell, Jonathan A.</creatorcontrib><creatorcontrib>Mangus, Richard S.</creatorcontrib><creatorcontrib>Hollinger, Edward F.</creatorcontrib><creatorcontrib>Taber, Tim E.</creatorcontrib><creatorcontrib>Goble, Michelle L.</creatorcontrib><creatorcontrib>Mohler, Elaine</creatorcontrib><creatorcontrib>Milgrom, Martin L.</creatorcontrib><creatorcontrib>Powelson, John A.</creatorcontrib><title>The case for pancreas after kidney transplantation</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>: Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti‐thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One‐yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus‐based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cadaver</subject><subject>Diabetic Nephropathies - surgery</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>immunosuppression</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Transplantation</subject><subject>Living Donors</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>pancreas after kidney transplantation</subject><subject>Pancreas Transplantation</subject><subject>rabbit anti-thymocyte globulin</subject><subject>Retrospective Studies</subject><subject>simultaneous kidney and pancreas transplantation</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>survival</subject><subject>Tissue and Organ Procurement - standards</subject><subject>Tissue, organ and graft immunology</subject><subject>transplant outcomes</subject><subject>Waiting Lists</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkFtLwzAYhoMobh7-gvRG71pzatqANzJ0KkPnHHgZvqUJduvamXS4_XuzA_PWQMhH8rzJlwehiOCEhHE7TQiTMsaY0IRiLJMwpUhWR6h7ODhGXSwxDbVgHXTm_TTsCiLSU9QhkqdMcNpFdPxlIg3eRLZx0QJq7Qz4CGxrXDQri9qso9ZB7RcV1C20ZVNfoBMLlTeX-_UcfTw-jHtP8eCt_9y7H8SaMy5iXoAFSWRhM2InDLSQuWZWaAEFh8zKlEpiQVBcMDGxONWSc4ph2-SEnaOb3a0L13wvjW_VvPTaVKEN0yy9ElmaSU5EAPMdqF3jvTNWLVw5B7dWBKuNLTVVGylqI0VtbKmtLbUK0av9G8vJ3BR_wb2eAFzvAfAaKhtE6NIfOEpympI8C9zdjvspK7P-dwOqNx6FIsTjXbz0rVkd4uBm4ZssS9Xna1-NesOXbDh8Vzn7BfVhk7Y</recordid><startdate>200908</startdate><enddate>200908</enddate><creator>Fridell, Jonathan A.</creator><creator>Mangus, Richard S.</creator><creator>Hollinger, Edward F.</creator><creator>Taber, Tim E.</creator><creator>Goble, Michelle L.</creator><creator>Mohler, Elaine</creator><creator>Milgrom, Martin L.</creator><creator>Powelson, John A.</creator><general>Blackwell Publishing Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200908</creationdate><title>The case for pancreas after kidney transplantation</title><author>Fridell, Jonathan A. ; Mangus, Richard S. ; Hollinger, Edward F. ; Taber, Tim E. ; Goble, Michelle L. ; Mohler, Elaine ; Milgrom, Martin L. ; Powelson, John A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4346-4dafa919df71fb3ac698c3f6c6ad4a7f95291fa620d36bf05c94420a01616b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cadaver</topic><topic>Diabetic Nephropathies - surgery</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>immunosuppression</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Transplantation</topic><topic>Living Donors</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>pancreas after kidney transplantation</topic><topic>Pancreas Transplantation</topic><topic>rabbit anti-thymocyte globulin</topic><topic>Retrospective Studies</topic><topic>simultaneous kidney and pancreas transplantation</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>survival</topic><topic>Tissue and Organ Procurement - standards</topic><topic>Tissue, organ and graft immunology</topic><topic>transplant outcomes</topic><topic>Waiting Lists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fridell, Jonathan A.</creatorcontrib><creatorcontrib>Mangus, Richard S.</creatorcontrib><creatorcontrib>Hollinger, Edward F.</creatorcontrib><creatorcontrib>Taber, Tim E.</creatorcontrib><creatorcontrib>Goble, Michelle L.</creatorcontrib><creatorcontrib>Mohler, Elaine</creatorcontrib><creatorcontrib>Milgrom, Martin L.</creatorcontrib><creatorcontrib>Powelson, John A.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fridell, Jonathan A.</au><au>Mangus, Richard S.</au><au>Hollinger, Edward F.</au><au>Taber, Tim E.</au><au>Goble, Michelle L.</au><au>Mohler, Elaine</au><au>Milgrom, Martin L.</au><au>Powelson, John A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The case for pancreas after kidney transplantation</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2009-08</date><risdate>2009</risdate><volume>23</volume><issue>4</issue><spage>447</spage><epage>453</epage><pages>447-453</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract>: Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti‐thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One‐yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus‐based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19453642</pmid><doi>10.1111/j.1399-0012.2009.00996.x</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Biological and medical sciences Cadaver Diabetic Nephropathies - surgery Drug Therapy, Combination Female Fundamental and applied biological sciences. Psychology Fundamental immunology Graft Survival Humans immunosuppression Immunosuppressive Agents - therapeutic use Kaplan-Meier Estimate Kidney Transplantation Living Donors Male Medical sciences Middle Aged pancreas after kidney transplantation Pancreas Transplantation rabbit anti-thymocyte globulin Retrospective Studies simultaneous kidney and pancreas transplantation Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system survival Tissue and Organ Procurement - standards Tissue, organ and graft immunology transplant outcomes Waiting Lists |
| title | The case for pancreas after kidney transplantation |
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