mTOR Inhibitor in Combination with Cyclosporine as Primary Maintenance Immunosuppression in Combined Kidney/Pancreas Transplant Recipients

We report our experience employing a steroid-free, mammalian target of rapamycin (mTOR) inhibitor –based immunosuppression regimen in pancreas transplantation and review literature germane to the use of this regimen.Recent FindingsIn our experience, using mTOR inhibitor –based, steroid-free immunosuppression with low-dose cyclosporine and anti-thymocyte globulin (ATG) induction in 309 combined kidney/pancreas transplants resulted in one-year patient survival and death censored graft survivals of 95.8%, 93.5% (pancreas), and 96.1% (kidney). The biopsy-proven acute rejection incidence was 15.2% at 1 year. De novo donor-specific antibodies developed in 9.4% at last follow-up. Little data currently exists reporting steroid-free, mTOR-based immunosuppression in pancreas transplant recipients. Excellent results have been reported in a small cohort of 25 recipien ts in Germany. Thus, data used in kidney transplant recipients must be extrapolated to pancreas transplantation.SummaryThere are some data, including our own, that indicate there are good outcomes with this immunosuppression regimen in combined kidney and pancreas recipients. Data suggest that avoidance of steroids and minimizing CNI exposure are desirable attributes to pancreas transplant immunosuppression to optimize post-transplant pancreas function.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research