Minimization protocols in pancreas transplantation

Transplant International : Official Journal of the European Society for Organ Transplantation
D Cantarovich, Fabio Vistoli

Abstract

Diagnosis of immunologic injury (acute and chronic) is much more difficult in pancreas transplants when compared with transplants of other organs. Currently, the immunosuppressive regimen for induction involves calcineurin inhibitors (CNI), antimetabolites and corticosteroids (Cs). This strong and nonspecific regimen does not take into consideration pancreas specificities (i.e. the need to avoid diabetogenic compounds). For obvious reasons, CNI might be calling for review, if permanently indicated in recipients of solitary pancreas with mild renal dysfunction. CNI as well as corticosteroids may induce hyperglycemia and contribute to differential diagnosis of a rejection process. However, in spite of the benefits accruing from withdrawal of above immunosuppressive agents, minimization or avoidance of these drugs could be dangerous and may end up with graft loss (i.e. antibody-mediated process). Long-term results of pancreas transplantation are now achieving comparable survival rates similar to the transplant of traditional organs such as kidney and liver. As a consequence, the physicians' objectives are to prolong the patient's quality of life and organ function as long as possible. Weaning strategies in regard to CNI and steroi...Continue Reading

References

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Citations

Feb 9, 2011·Diabetes Technology & Therapeutics·Cyrus JahansouzKenneth L Brayman
Aug 30, 2012·Transplantation·Érika B RangelJose O Medina-Pestana
Jul 4, 2012·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Osama GheithMona Ibraheim
Jul 26, 2012·Current Diabetes Reports·Ugo BoggiGabriella Amorese
Dec 21, 2012·Current Opinion in Organ Transplantation·Michael Kimelman, Gerald Brandacher
Nov 19, 2013·Expert Review of Clinical Immunology·Robert J StrattaGiuseppe Orlando
Sep 27, 2014·Expert Opinion on Drug Metabolism & Toxicology·Erika B Rangel
Sep 18, 2012·Expert Opinion on Drug Metabolism & Toxicology·Erika B Rangel
Mar 12, 2016·The American Journal of Medicine·Shamik DholakiaPeter J Friend
Apr 14, 2012·The Mount Sinai Journal of Medicine, New York·Anja RichterBernd Schröppel
Dec 24, 2009·Transplant International : Official Journal of the European Society for Organ Transplantation·Erika B RangelMarcelo Perosa
Mar 13, 2014·Transplant International : Official Journal of the European Society for Organ Transplantation·Massimo BaraldoUgolino Livi
Feb 6, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Diego CantarovichMaryvonne Hourmant
May 26, 2009·Lancet·Steve A WhiteDavid E R Sutherland

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