Successful simultaneous islet-kidney transplantation using a steroid-free immunosuppression: two-year follow-up

Am J Transplant. 2004 Jul;4(7):1117-23. doi: 10.1111/j.1600-6143.2004.00468.x.

Abstract

We report on the feasibility of a glucocorticoid-free immunosuppression (sirolimus, low-dose tacrolimus, and daclizumab) in simultaneous islet-kidney transplantation in nine patients with type 1 diabetes. There was one renal primary nonfunction. Renal function (n = 8) as assessed by creatinine and creatinine clearance over time was 103 +/- 6 micromol/L and 64 +/- 6 mL/min/1.73 m(2), respectively. Five out of six patients with >or= 2 islet transplantations became insulin independent. The mean HbA(1c) during the follow-up period for all patients after transplantation is 6.2 +/- 0.9% as compared with 8.7 +/- 1.9% prior to transplant. These results in patients with a median follow-up of 2.3 years suggest that kidney transplantation under a glucocorticoid-free immunosuppression is feasible, and that the rate of insulin independence of 80% can be achieved not only in patients with no or minimal diabetes complications, but also in patients with more advanced late complications and in conjunction with kidney transplantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Area Under Curve
  • C-Peptide / blood
  • C-Peptide / chemistry
  • Creatinine / metabolism
  • Daclizumab
  • Diabetes Complications
  • Female
  • Follow-Up Studies
  • Glucocorticoids / metabolism
  • Hemoglobins / metabolism
  • Humans
  • Immune Tolerance
  • Immunoglobulin G / therapeutic use
  • Immunosuppression
  • Immunosuppressive Agents / pharmacology*
  • Insulin / metabolism
  • Islets of Langerhans
  • Islets of Langerhans Transplantation / methods*
  • Kidney / metabolism
  • Kidney / physiology
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Pancreas / metabolism
  • Protein Conformation
  • Sirolimus / therapeutic use
  • Tacrolimus / therapeutic use
  • Time Factors
  • Tissue and Organ Procurement
  • Transplantation Conditioning

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • C-Peptide
  • Glucocorticoids
  • Hemoglobins
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Insulin
  • Creatinine
  • Daclizumab
  • Sirolimus
  • Tacrolimus