RESULTS OF PANCREAS TRANSPLANTATION FOLLOWING STEROID WITHDRAWAL UNDER FK506-BASED IMMUNOSUPPRESSION

Abstract

98 We have previously reported that tacrolimus provides excellent long term function in patients undergoing pancreas transplantation. One of the benefits provided by tacrolimus in primary renal transplant patients is the ability to withdraw steroids in up to 60% of patients. We herein report for the first time that steroid withdrawal is also safe and effective in pancreas transplant recipients under tacrolimus immunosuppression. Between July 4, 1994, and December 23, 1997, 131 pancreas transplants were performed at our center. One hundred-and-one patients had simultaneous kidney-pancreas, 11 patients had pancreas after kidney and 7 patients had solitary pancreatic transplants under tacrolimus-based immunosuppression. The first 51 patients received azathioprine and the last 68 patients received mycophenolate mofetil in addition to FK506 and prednisone. Twelve patients were excluded from analysis because of early allograft loss or early patient death. Minimum followup was 1 year. Sixty-four patients (54%) were withdrawn from steroids after a mean of 14.9 months after transplantation. During a mean follow-up of 19.6 months after steroid withdrawal, only 3 patients (4.7%) developed an acute rejection episode. All rejection episodes responded to pulsed steroid therapy. The demographics of the steroid withdrawal group and the group that never received steroid withdrawal are presented in the following table:TableUnder FK506-based immunosuppression, it is possible to achieve steroid withdrawal in the majority of pancreas transplant patients. Acute rejection episodes that occur after steroid withdrawal are infrequent and are easily reversible.