A large, prospective, randomized, open-label, multicentre study of corticosteroid withdrawal in SPK transplantation: a 3-year report
1 Transplantation Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and 2 Department of Kidney and Pancreas Transplantation and Organ Procurement, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
Correspondence and offprint requests to: Dr Jacques Malaise, Department of Kidney and Pancreas Transplantation and Organ Procurement, Cliniques Universitaires St Luc, Université Catholique de Louvain, Avenue Hippocrate, 10/2207, B-1200 Brussels, Belgium. Email: jacques.malaise{at}chir.ucl.ac.be
Background. Simultaneous pancreas–kidney (SPK) transplantation is the treatment of choice for selected diabetic patients. Corticosteroids are an important element of immunosuppressive protocols, but their long-term use has detrimental effects on patients' health, necessitating eventual discontinuation.
Methods. This prospective study evaluated the safety and feasibility of corticosteroid withdrawal in 205 SPK transplant recipients randomized to immunosuppressive treatment with either tacrolimus and mycophenolate mofetil (MMF) (n = 103) or cyclosporin microemulsion (ME) and MMF (n = 102).
Results. Corticosteroid withdrawal was successful in the majority of in-study patients (66% tacrolimus, 73% cyclosporin-ME). Compared with out-of-study patients or those continuing corticosteroid therapy, in-study patients withdrawn from corticosteroids experienced fewer pancreas or kidney graft losses, fewer episodes of acute rejection and were less likely to be withdrawn from the study. Acute rejection occurred after corticosteroid withdrawal in two patients who had a previous rejection and in five patients who were rejection-free before corticosteroid withdrawal. No rejection episodes were associated with graft loss or immediate serious consequences. Overall, corticosteroid withdrawal was achieved with an increase in the dose of both MMF and tacrolimus.
Conclusions. A long-term survey of corticosteroid withdrawal in SPK transplantation with multifactorial analyses is necessary to confirm these early results and to evaluate the positive effects on glucose metabolism and hypertension.
Keywords: corticosteroid withdrawal; cyclosporin microemulsion; rejection; simultaneous pancreas–kidney transplantation; tacrolimus