Very early steroid withdrawal in simultaneous pancreas–kidney transplants
Background. Simultaneous pancreas–kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, earl...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2007-03, Vol.22 (3), p.899-905 |
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| container_title | Nephrology, dialysis, transplantation |
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| creator | Aoun, Mabel Eschewege, Pascal Hamoudi, Yacine Beaudreuil, Severine Duranteau, Jacques Cheisson, Gaelle Noel, Christian Benoit, Gerard Charpentier, Bernard Durrbach, Antoine |
| description | Background. Simultaneous pancreas–kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, early withdrawal of corticosteroids may be an important issue. Methods. A total of 24 consecutive patients with type 1 diabetes mellitus had been treated by SPK transplantation. All of them had a short induction therapy with anti-thymoglobulin (ATG) and steroids for only 4 days, association with CellCept and tacrolimus. The rate of acute rejection, graft and patient survival and side effects have been analysed. Results. Patient and kidney survival was 100% and the pancreas survival was 95.6% at 1 year. The rate of acute rejection of kidney and pancreas was 4.2% and 8.3% at 6 months, respectively. The mean serum creatinine was 98.9±19.6 µmol/l and the mean HbA1c concentration was 5.1%±0.5% at 6 months. Only four patients developed a cytomegalovirus primo-infection, associated in one case with pneumonia, whereas 75% of patients developed a bacterial infection. Because of the occurrence of leucopenia and/or diarrhoea, CellCept has been dramatically decreased in 33% of cases and required the re-introduction of steroids. Conclusion. A short induction with ATG and steroids associated with a chronic therapy with CellCept and tacrolimus is safe and efficient in preventing acute renal rejection in SPK. |
| doi_str_mv | 10.1093/ndt/gfl660 |
| format | Article |
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Simultaneous pancreas–kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, early withdrawal of corticosteroids may be an important issue. Methods. A total of 24 consecutive patients with type 1 diabetes mellitus had been treated by SPK transplantation. All of them had a short induction therapy with anti-thymoglobulin (ATG) and steroids for only 4 days, association with CellCept and tacrolimus. The rate of acute rejection, graft and patient survival and side effects have been analysed. Results. Patient and kidney survival was 100% and the pancreas survival was 95.6% at 1 year. The rate of acute rejection of kidney and pancreas was 4.2% and 8.3% at 6 months, respectively. The mean serum creatinine was 98.9±19.6 µmol/l and the mean HbA1c concentration was 5.1%±0.5% at 6 months. Only four patients developed a cytomegalovirus primo-infection, associated in one case with pneumonia, whereas 75% of patients developed a bacterial infection. Because of the occurrence of leucopenia and/or diarrhoea, CellCept has been dramatically decreased in 33% of cases and required the re-introduction of steroids. Conclusion. A short induction with ATG and steroids associated with a chronic therapy with CellCept and tacrolimus is safe and efficient in preventing acute renal rejection in SPK.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfl660</identifier><identifier>PMID: 17127698</identifier><identifier>CODEN: NDTREA</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Acute Disease ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Autoantibodies - therapeutic use ; Biological and medical sciences ; Cytomegalovirus ; Diabetes Mellitus, Type 1 - surgery ; Drug Therapy, Combination ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Follow-Up Studies ; Glucocorticoids - administration & dosage ; Glucocorticoids - therapeutic use ; Graft Rejection - epidemiology ; Graft Rejection - prevention & control ; Graft Survival ; Humans ; Immunosuppressive Agents - therapeutic use ; Incidence ; Intensive care medicine ; Kidney Transplantation - methods ; Kidneys ; leucopoenia ; Male ; Medical sciences ; Mycophenolic Acid - analogs & derivatives ; Mycophenolic Acid - therapeutic use ; Nephrology. Urinary tract diseases ; pancreas transplantation ; Pancreas Transplantation - methods ; Prodrugs ; Prospective Studies ; renal transplantation ; steroids withdrawal ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Survival Rate ; Tacrolimus - therapeutic use ; Time Factors ; Treatment Outcome ; Tumors of the urinary system</subject><ispartof>Nephrology, dialysis, transplantation, 2007-03, Vol.22 (3), p.899-905</ispartof><rights>The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org 2006</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Mar 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-cd9c73b2120efc7cce8ff576e681f83aeef1c9a696c1837fe4e0dedaa13dfc8a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18578561$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17127698$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aoun, Mabel</creatorcontrib><creatorcontrib>Eschewege, Pascal</creatorcontrib><creatorcontrib>Hamoudi, Yacine</creatorcontrib><creatorcontrib>Beaudreuil, Severine</creatorcontrib><creatorcontrib>Duranteau, Jacques</creatorcontrib><creatorcontrib>Cheisson, Gaelle</creatorcontrib><creatorcontrib>Noel, Christian</creatorcontrib><creatorcontrib>Benoit, Gerard</creatorcontrib><creatorcontrib>Charpentier, Bernard</creatorcontrib><creatorcontrib>Durrbach, Antoine</creatorcontrib><title>Very early steroid withdrawal in simultaneous pancreas–kidney transplants</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Background. Simultaneous pancreas–kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, early withdrawal of corticosteroids may be an important issue. Methods. A total of 24 consecutive patients with type 1 diabetes mellitus had been treated by SPK transplantation. All of them had a short induction therapy with anti-thymoglobulin (ATG) and steroids for only 4 days, association with CellCept and tacrolimus. The rate of acute rejection, graft and patient survival and side effects have been analysed. Results. Patient and kidney survival was 100% and the pancreas survival was 95.6% at 1 year. The rate of acute rejection of kidney and pancreas was 4.2% and 8.3% at 6 months, respectively. The mean serum creatinine was 98.9±19.6 µmol/l and the mean HbA1c concentration was 5.1%±0.5% at 6 months. Only four patients developed a cytomegalovirus primo-infection, associated in one case with pneumonia, whereas 75% of patients developed a bacterial infection. Because of the occurrence of leucopenia and/or diarrhoea, CellCept has been dramatically decreased in 33% of cases and required the re-introduction of steroids. Conclusion. A short induction with ATG and steroids associated with a chronic therapy with CellCept and tacrolimus is safe and efficient in preventing acute renal rejection in SPK.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Autoantibodies - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cytomegalovirus</subject><subject>Diabetes Mellitus, Type 1 - surgery</subject><subject>Drug Therapy, Combination</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - prevention & control</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Incidence</subject><subject>Intensive care medicine</subject><subject>Kidney Transplantation - methods</subject><subject>Kidneys</subject><subject>leucopoenia</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Mycophenolic Acid - therapeutic use</subject><subject>Nephrology. Urinary tract diseases</subject><subject>pancreas transplantation</subject><subject>Pancreas Transplantation - methods</subject><subject>Prodrugs</subject><subject>Prospective Studies</subject><subject>renal transplantation</subject><subject>steroids withdrawal</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Survival Rate</subject><subject>Tacrolimus - therapeutic use</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tumors of the urinary system</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c9qFTEUBvAgFnutbnwAGQRdCGOTyUz-LEtRKy0URUtxE06TE02bOzMmM9S78x18Q5_ElLl4wYWussiPc5LvI-QJo68Y1fywd9PhFx-FoPfIirWC1g1X3X2yKpesph3V--RhzteUUt1I-YDsM8kaKbRakdMLTJsKIcVNlSdMQ3DVbZi-ugS3EKvQVzms5zhBj8OcqxF6mxDyrx8_b4LrcVNNCfo8Ruin_IjseYgZH2_PA_LpzeuPxyf12fnbd8dHZ7VtpZxq67SV_KphDUVvpbWovO-kQKGYVxwQPbMahBaWKS49tkgdOgDGnbcK-AF5scwd0_BtxjyZdcgWY1weaYSmXLS0-y9sqOJCd6LAZ3_B62FOffmEaZhiJVnJC3q5IJuGnBN6M6awhrQxjJq7IkwpwixFFPx0O3G-WqPb0W3yBTzfAsgWoi8x2pB3TnVSdYLt3DCP_15YLy6UGr__kZBujJBcdubk8rNhl_TivfigTMt_A6FVr_c</recordid><startdate>20070301</startdate><enddate>20070301</enddate><creator>Aoun, Mabel</creator><creator>Eschewege, Pascal</creator><creator>Hamoudi, Yacine</creator><creator>Beaudreuil, Severine</creator><creator>Duranteau, Jacques</creator><creator>Cheisson, Gaelle</creator><creator>Noel, Christian</creator><creator>Benoit, Gerard</creator><creator>Charpentier, Bernard</creator><creator>Durrbach, Antoine</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</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>7QP</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20070301</creationdate><title>Very early steroid withdrawal in simultaneous pancreas–kidney transplants</title><author>Aoun, Mabel ; Eschewege, Pascal ; Hamoudi, Yacine ; Beaudreuil, Severine ; Duranteau, Jacques ; Cheisson, Gaelle ; Noel, Christian ; Benoit, Gerard ; Charpentier, Bernard ; Durrbach, Antoine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-cd9c73b2120efc7cce8ff576e681f83aeef1c9a696c1837fe4e0dedaa13dfc8a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Autoantibodies - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cytomegalovirus</topic><topic>Diabetes Mellitus, Type 1 - surgery</topic><topic>Drug Therapy, Combination</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - prevention & control</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Incidence</topic><topic>Intensive care medicine</topic><topic>Kidney Transplantation - methods</topic><topic>Kidneys</topic><topic>leucopoenia</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mycophenolic Acid - analogs & derivatives</topic><topic>Mycophenolic Acid - therapeutic use</topic><topic>Nephrology. Urinary tract diseases</topic><topic>pancreas transplantation</topic><topic>Pancreas Transplantation - methods</topic><topic>Prodrugs</topic><topic>Prospective Studies</topic><topic>renal transplantation</topic><topic>steroids withdrawal</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Survival Rate</topic><topic>Tacrolimus - therapeutic use</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tumors of the urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aoun, Mabel</creatorcontrib><creatorcontrib>Eschewege, Pascal</creatorcontrib><creatorcontrib>Hamoudi, Yacine</creatorcontrib><creatorcontrib>Beaudreuil, Severine</creatorcontrib><creatorcontrib>Duranteau, Jacques</creatorcontrib><creatorcontrib>Cheisson, Gaelle</creatorcontrib><creatorcontrib>Noel, Christian</creatorcontrib><creatorcontrib>Benoit, Gerard</creatorcontrib><creatorcontrib>Charpentier, Bernard</creatorcontrib><creatorcontrib>Durrbach, Antoine</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>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aoun, Mabel</au><au>Eschewege, Pascal</au><au>Hamoudi, Yacine</au><au>Beaudreuil, Severine</au><au>Duranteau, Jacques</au><au>Cheisson, Gaelle</au><au>Noel, Christian</au><au>Benoit, Gerard</au><au>Charpentier, Bernard</au><au>Durrbach, Antoine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Very early steroid withdrawal in simultaneous pancreas–kidney transplants</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2007-03-01</date><risdate>2007</risdate><volume>22</volume><issue>3</issue><spage>899</spage><epage>905</epage><pages>899-905</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><coden>NDTREA</coden><abstract>Background. Simultaneous pancreas–kidney (SPK) transplantation is an effective treatment for patients suffering from type 1 diabetes mellitus. Conventional immunosuppressive treatments include steroids that may induce insulin resistance and are responsible for many side effects. In de novo SPK, early withdrawal of corticosteroids may be an important issue. Methods. A total of 24 consecutive patients with type 1 diabetes mellitus had been treated by SPK transplantation. All of them had a short induction therapy with anti-thymoglobulin (ATG) and steroids for only 4 days, association with CellCept and tacrolimus. The rate of acute rejection, graft and patient survival and side effects have been analysed. Results. Patient and kidney survival was 100% and the pancreas survival was 95.6% at 1 year. The rate of acute rejection of kidney and pancreas was 4.2% and 8.3% at 6 months, respectively. The mean serum creatinine was 98.9±19.6 µmol/l and the mean HbA1c concentration was 5.1%±0.5% at 6 months. Only four patients developed a cytomegalovirus primo-infection, associated in one case with pneumonia, whereas 75% of patients developed a bacterial infection. Because of the occurrence of leucopenia and/or diarrhoea, CellCept has been dramatically decreased in 33% of cases and required the re-introduction of steroids. Conclusion. A short induction with ATG and steroids associated with a chronic therapy with CellCept and tacrolimus is safe and efficient in preventing acute renal rejection in SPK.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>17127698</pmid><doi>10.1093/ndt/gfl660</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Autoantibodies - therapeutic use Biological and medical sciences Cytomegalovirus Diabetes Mellitus, Type 1 - surgery Drug Therapy, Combination Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies Glucocorticoids - administration & dosage Glucocorticoids - therapeutic use Graft Rejection - epidemiology Graft Rejection - prevention & control Graft Survival Humans Immunosuppressive Agents - therapeutic use Incidence Intensive care medicine Kidney Transplantation - methods Kidneys leucopoenia Male Medical sciences Mycophenolic Acid - analogs & derivatives Mycophenolic Acid - therapeutic use Nephrology. Urinary tract diseases pancreas transplantation Pancreas Transplantation - methods Prodrugs Prospective Studies renal transplantation steroids withdrawal Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Survival Rate Tacrolimus - therapeutic use Time Factors Treatment Outcome Tumors of the urinary system |
| title | Very early steroid withdrawal in simultaneous pancreas–kidney transplants |
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