Results of pancreas transplantation after @entity134 withdrawal under XXXX immunosuppression.

@entity1 @entity8 @entity134 @entity1140 @entity230 @entity1011 @entity413
PURPOSE: The results of @entity134 withdrawal in pancreas transplant recipients under @entity1140 immunosuppression were analyzed. METHODS: From July 4, 1994 until April 30, 1998, 147 pancreas transplantations were performed in 141 @entity1 , including 126 simultaneous @entity8 . Baseline immunosuppression consisted of @entity1140 and @entity230 without antilymphocyte induction. Twenty-three @entity1 were excluded from analysis because of early graft loss in 17 cases, retransplantation in 5 cases, and simultaneous pancreas-kidney transplantation after heart transplantation in 1 @entity1 . RESULTS: With a mean follow-up of 2.8+/-1.1 years (range 1.0 to 4.8 years), complete @entity134 withdrawal was achieved in 58 (47%) @entity1 with a mean time to @entity134 withdrawal of 15.2+/-8 months (range 4 to 40 months after transplantation). Of the entire cohort of 141 @entity1 , overall 1-, 2-, and 4-year @entity1 survival rates were 98%, 95.5%, and 86%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 83%, 80%, and 71% (pancreas) and 95%, 91%, and 84% (kidney), respectively. Of the 124 @entity1 analyzed for @entity134 withdrawal, 1-, 2-, and 4-year @entity1 survival rates were 98%, 97%, and 92%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 98%, 91.5%, 83% (pancreas) and 97%, 95%, and 91% (kidney). @entity1 , pancreas, and kidney survival rates at 1 year were 100%, 100%, and 98% (off @entity230 ) versus 97%, 91%, and 96% (on @entity230 , all NS) and at 4 years were 100%, 94%, and 95% (off @entity230 ) versus 78%, 68%, and 85% (on @entity230 , P = 0.01, 0.002, and NS, respectively). The cumulative risk of rejection at the time of follow-up was 76% for @entity1 on @entity230 versus 74% for @entity1 off @entity230 (P = NS). Seven @entity1 originally tapered off @entity230 were treated for subsequent rejection episodes, which were all @entity134 sensitive, and two of these seven @entity1 are currently off @entity230 . Thirteen patients received antilymphocyte therapy for @entity134 -resistant rejection, five of whom are now off @entity230 . @entity1140 trough levels were 9.3+/-2.4 ng/ml (off @entity230 ) and 9.7+/-4.3 (on @entity230 , P = NS). Mean fasting @entity413 levels were 98+/-34 mg/dl (off @entity230 ) and 110+/-41 mg/dl (on @entity230 , P = NS). Mean glycosylated hemoglobin levels were 5.2+/-0.9% (off @entity230 ) and 6.2+/-2.1% (on @entity230 , P = 0.02), and mean serum @entity1011 levels were 1.4+/-0.8 mg/dl (off @entity230 ) and 1.7+/-1.0 mg/dl (on @entity230 , P = 0.02). CONCLUSION: These data show for the first time that @entity134 withdrawal can be safely accomplished in pancreas transplant recipients maintained on @entity1140 -based immunosuppression. @entity134 withdrawal is associated with excellent @entity1 and graft survival with no increase in the cumulative risk of rejection.
