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Mycophenolate mofetil in pancreas transplantation
R W Gruessner1, D E Sutherland, M B Drangstveit
1Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Transplantation
|August 29, 1998
Summary
Mycophenolate mofetil (MMF) combined with tacrolimus significantly reduced rejection episodes in pancreas transplant recipients. While effective, gastrointestinal toxicity led to conversions to azathioprine, especially in solitary pancreas transplant patients.
Area of Science:
- Transplantation immunology
- Immunosuppressive therapy
Background:
- Mycophenolate mofetil (MMF) is known to reduce acute rejection in kidney transplants.
- Long-term outcomes of MMF with tacrolimus after pancreas transplantation require further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of MMF combined with tacrolimus in pancreas transplant recipients.
- To compare outcomes of MMF versus azathioprine in a large single-center pancreas transplant cohort.
Main Methods:
- A retrospective analysis of 120 pancreas transplant recipients treated with MMF and tacrolimus.
- Matched-pair analysis comparing MMF with azathioprine using International Pancreas Transplant Registry data.
- Categorization by transplant type: simultaneous pancreas-kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA).
Main Results:
- One-year patient survival exceeded 98% across all transplant types.
- MMF significantly reduced the incidence of first rejection episodes at 1 year (15% vs. 43% with azathioprine, P = 0.0003).
- Gastrointestinal toxicity was the primary reason for conversion from MMF to azathioprine, particularly in PTA recipients.
Conclusions:
- The combination of MMF and tacrolimus is effective and safe for pancreas transplantation.
- MMF significantly lowers acute rejection rates in SPK recipients compared to azathioprine.
- Higher rates of gastrointestinal toxicity necessitate careful monitoring and potential conversion strategies.