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Immunosuppression in pancreas transplantation: progress, problems and perspective
1Department of Surgery, University of Tennessee-Memphis 38163-2116, USA. rstratta@utmem1.utmem.edu
Transplant Immunology
|October 20, 1998
Summary
Pancreas transplantation survival rates have improved significantly due to evolving immunosuppression protocols. New drug combinations offer better rejection control, making pancreas transplants a viable option for diabetic patients.
Area of Science:
- Nephrology and Immunology
- Transplantation Medicine
Background:
- Over 10,000 pancreas transplants performed worldwide by 1997, with 88% being simultaneous kidney-pancreas transplants (SKPTs).
- Current 1-year patient survival exceeds 90%, with graft survival rates of 80% for SKPT, 70% for sequential pancreas after kidney transplant (PAKT), and 65% for pancreas transplant alone (PTA).
- Rejection accounted for 32% of graft failures in the first year post-transplantation.
Purpose of the Study:
- To review the evolution of immunosuppressive protocols in pancreas transplantation.
- To assess the impact of new immunosuppressive agents on graft survival and rejection rates.
- To evaluate the current status and future directions of pancreas transplantation as a treatment for diabetes.
Main Methods:
- Analysis of registry data on pancreas transplant outcomes and immunosuppressive strategies.
- Review of changes in immunosuppressive regimens, including induction therapy and maintenance therapy (calcineurin inhibitors, corticosteroids, anti-metabolites).
- Comparison of outcomes with different immunosuppressive drug formulations (Sandimmune vs. Neoral, azathioprine vs. mycophenolate mofetil) and the use of antibody induction.
Main Results:
- Significant decrease in 1-year immunologic graft loss rates from 1994-1997: 2% for SKPT, 9% for PAKT, and 16% for PTA.
- New immunosuppressive agents provide more effective rejection control.
- Solitary pancreas transplantation is becoming an accepted treatment option for diabetic patients.
Conclusions:
- Evolving immunosuppressive strategies are improving pancreas transplant outcomes and reducing graft loss.
- New drug combinations are enhancing graft survival and enabling pancreas transplantation for a broader patient population.
- Future research should focus on optimizing immunosuppression to minimize toxicity, improve long-term metabolic control, and enhance quality of life.