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NDT Advance Access originally published online on November 24, 2006
Nephrology Dialysis Transplantation 2007 22(3):899-905; doi:10.1093/ndt/gfl660
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Very early steroid withdrawal in simultaneous pancreas–kidney transplants

Mabel Aoun1, Pascal Eschewege2, Yacine Hamoudi2, Severine Beaudreuil1, Jacques Duranteau3, Gaelle Cheisson3, Christian Noel1, Gerard Benoit2, Bernard Charpentier1 and Antoine Durrbach1

1Nephrology Unit Le Kremlin Bicetre, INSERM U542, IFRNT, 2Urology Unit Le Kremlin Bicetre and 3Surgical Intensive Care Le Kremlin Bicetre, Nephrology Unit Lille, France

Correspondence and offprint requests to: Antoine Durrbach, Nephrology unit, Bicetre Hospital, Le Kremlin Bicetre, France. Email: antoine.durrbach{at}bct.aphp.fr



  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.

Keywords: leucopoenia; pancreas transplantation; renal transplantation; steroids withdrawal

Received for publication: 14. 5.06
Accepted in revised form: 12.10.06


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