Steroid withdrawal in pancreas transplant recipients

Background. Numerous studies of steroid withdrawal have been carried out in kidney and liver transplant recipients, but only a few in pancreas transpl ant recipients. Yet, pancreas transplant recipients could have significant long-term benefits from steroid withdrawal. Methods. We performed a retrospective analysis to determine the feasibility of steroid withdrawal in pancreas transplant recipients. Results. Of 360 recipients who underwent a pancreas transplant between Janu ary 1, 1994 and June 30, 1998, 14 attempted steroid withdrawal (12 simultan eous pancreas-kidney [SPK]; 2 pancreas transplant alone [PTA]). Reasons for steroid withdrawal were bone fractures (n = 3), psychiatric disorders (n = 2), severe acne (n = 1), recurrent infections (n = 4), and problems with h ypercholesterolemia or hypertension (n = 4). All 14 were maintained on tacr olimus and mycophenolate mofetil (MMF) immunosuppression, except for 1 who was on tacrolimus and azathioprine (AZA). Of the 14 recipients, 11 had no e pisodes of acute rejection before steroid withdrawal. The remaining 3 had o ne or more acute rejection episodes. Of the 14 recipients, 10 (72%) currently remain off steroids (mean follow-u p Is months, range 5-51 months). However, 4 recipients have resumed steroid s: 2 after an acute rejection episode (at 2 and 21 months post-withdrawal) and 2 because of leukopenia (WBC < 3000) and an inability to tolerate full- dose MMF. Steroid withdrawal was unsuccessful in both PTA recipients and in 2 of the 12 SPK recipients. All 14 recipients currently have a functioning pancreas graft. However, 1 o f the SPK recipients, in whom steroid withdrawal failed, has developed chro nic kidney rejection and is now back on hemodialysis awaiting a retransplan t. Conclusion. Steroid withdrawal is possible in up to 70% of pancreas transpl ant recipients. Further studies are necessary to define ideal candidates fo r steroid withdrawal. Based on the results of this analysis, we have launch ed a prospective, randomized trial of steroid withdrawal in pancreas transp lant recipients.