Late Conversion to Sirolimus or Everolimus After Pancreas Transplant
| Autor: | Cláudio S. Melaragno, Adriano Miziara Gonzalez, Marcelo Moura Linhares, Erika B Rangel, Jose O. Medina-Pestana, Rubens Marcella-Neto, João Roberto de Sá, Alcides Augusto Salzedas-Neto |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Gastroenterology Internal medicine Humans Medicine Everolimus Adverse effect Kidney transplantation Retrospective Studies Immunosuppression Therapy Sirolimus Transplantation Proteinuria Drug Substitution business.industry Graft Survival Retrospective cohort study Middle Aged medicine.disease Kidney Transplantation Tacrolimus Treatment Outcome Cohort Female Surgery Pancreas Transplantation medicine.symptom business Immunosuppressive Agents medicine.drug |
| Zdroj: | Transplantation Proceedings. 52:1376-1379 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2020.02.028 |
| Popis: | Background Pancreas transplant is an effective treatment for insulin-dependent diabetic individuals with end-stage renal disease, yet immunosuppression-associated adverse events may adversely affect patient and graft survival. The aim of the study was to document whether mammalian target of rapamycin inhibitors (mTORi) are safe and effective as a second-line drug after pancreas transplant. Methodology An observational single-center study was performed in a cohort of 490 simultaneous pancreas–kidney transplant and 45 pancreas-after-kidney transplant individuals after conversion to mTORi (n = 13) owing to adverse events of either tacrolimus or mycophenolate. Results mTORi conversion was performed 11.5 ± 10.1 (range, 1-28) months after pancreas transplant, mainly owing to cytomegalovirus infection and gastrointestinal intolerance. We frequently observed clinical complications after mTORi conversion, yet creatinine, eGFR, proteinuria, fasting plasma glucose, HbA1c, and C-peptide remained stable throughout the study (mean follow-up 8.2 ± 5, range 1-17) years, as did the lipid profile (P > .05). However, graft loss occurred in almost 20% of patients owing to chronic alterations. Limitations The small number of patients and a single-center cohort were limitations of the study. Conclusions Late mTORi conversion is a safe and effective approach when tacrolimus or mycophenolate-mediated adverse events occur after pancreas transplant. |
| Databáze: | OpenAIRE |
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