Dual antibody induction and de novo use of everolimus enable low-dose tacrolimus with early corticosteroid withdrawal in simultaneous pancreas-kidney transplantation

Transpl Immunol. 2018 Oct:50:26-33. doi: 10.1016/j.trim.2018.06.001. Epub 2018 Jun 6.

Abstract

Background: To be an optimal immunosuppressive regimen after simultaneous pancreas kidney transplantation (SPK), low dose calcineurin inhibitor and early withdrawal of corticosteroids are desired.

Methods: Immunosuppressive regimen as such has been conducted consecutively in SPK recipients since 2009 in authors' institute. In addition to tacrolimus in low trough level and early corticosteroid withdraw, dual induction with basiliximab and low-dose thymoglobulin in combination with everolimus are the important components of the protocol.

Results: 25 consecutive primary SPK recipients were included in the study. Lymphocyte depletion by low dose thymoglobulin was limited to two weeks, and CD25 coating with basiliximab was detectable for 4 weeks. The BPAR within the first 12 months was 13%. During a median follow-up of 58 months, new-onset diabetes mellitus and renal function deterioration were rare events. No cytomegalovirus activation was encountered. The patients, pancreas and kidney graft survival at 1-year and 5-year was 100% and 94.4%, 95.8% and 95.8%, 100% and 100% respectively.

Keywords: Calcineurin inhibitor; Complication; Corticosteroids withdrawal; Immunosuppression; Induction; Simultaneous pancreas kidney transplantation.

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Antilymphocyte Serum / therapeutic use
  • Basiliximab / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Therapy, Combination
  • Everolimus / therapeutic use
  • Female
  • Follow-Up Studies
  • Graft Rejection / drug therapy*
  • Graft Rejection / mortality
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Pancreas Transplantation*
  • Remission Induction
  • Survival Analysis
  • Tacrolimus / therapeutic use
  • Withholding Treatment
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Basiliximab
  • Everolimus
  • thymoglobulin
  • Tacrolimus