Late Conversion to Sirolimus or Everolimus After Pancreas Transplant

Area of Science:

• Nephrology
• Transplantation Immunology
• Endocrinology

Background:

• Pancreas transplantation is a vital treatment for type 1 diabetes in end-stage renal disease patients.
• Standard immunosuppression regimens can lead to adverse events impacting patient and graft survival.
• Investigating alternative immunosuppressive strategies is crucial for improving transplant outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of mammalian target of rapamycin inhibitors (mTORi) as a second-line immunosuppression therapy post-pancreas transplant.
• To assess the impact of mTORi conversion on graft function, metabolic control, and clinical complications.

Main Methods:

• An observational, single-center study included pancreas transplant recipients converted to mTORi due to adverse events from tacrolimus or mycophenolate.
• The cohort comprised simultaneous pancreas-kidney transplant and pancreas-after-kidney transplant recipients.
• Data on clinical complications, graft function markers (creatinine, eGFR, proteinuria), metabolic parameters (glucose, HbA1c, C-peptide), and lipid profiles were analyzed.

Main Results:

• Conversion to mTORi occurred a median of 11.5 months post-transplant, primarily due to cytomegalovirus infection and gastrointestinal issues.
• Despite frequent clinical complications post-conversion, key markers of kidney function, glucose metabolism, and lipid profiles remained stable.
• Graft loss was observed in nearly 20% of patients, attributed to chronic alterations.

Conclusions:

• Late conversion to mTORi is a viable and effective strategy for pancreas transplant recipients experiencing adverse events from primary immunosuppressants.
• While generally safe for metabolic and renal parameters, careful monitoring for chronic complications and graft loss is warranted.
• The study's findings are limited by its small sample size and single-center design, necessitating further validation.