Immunosuppression for pancreas transplantation

Abstract

Purpose In this article, current practices and trends are reviewed in the application of induction and maintenance immunosuppressive agents as well as new trends in immunosuppression minimization in pancreas transplantation. Recent findings After the publication of multicenter clinical trials, there is now evidence on the use of induction therapy to reduce the incidence, timing, and severity of acute rejection episodes in pancreas transplantation. Usually a three-drug regimen is used for maintenance therapy in pancreas transplantation. There is also evidence-based information to support the combination of tacrolimus and mycophenolate mophetil as the preferred maintenance immunosuppressive in simultaneous pancreas-kidney transplantation. Increasing experience suggests that sirolimus may be a good alternative as a second agent in recipients of pancreas transplantation under tacrolimus therapy. Steroids continue to be part of the preferred three-drug maintenance immunosuppressive regimen in pancreas transplantation. However, there is now evidence suggesting that rapid discontinuation of steroids is safe and does not alter patient and graft survival nor the incidence and severity of acute rejection episodes. Currently, there is a lack of studies designed to investigate calcineurin inhibitor avoidance or withdrawal in pancreas transplantation. Summary Protocols that avoid or minimize the concomitant use of steroids and calcineurin inhibitors need to be evaluated. New strategies should aim to minimize the toxicity associated with immunotherapy in pancreas transplantation.