Abstract:
BACKGROUND:Numerous studies of steroid withdrawal have been carried out in kidney and liver transplant recipients, but only a few in pancreas transplant 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 January 1, 1994 and June 30, 1998, 14 attempted steroid withdrawal (12 simultaneous 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 hypercholesterolemia or hypertension (n = 4). All 14 were maintained on tacrolimus and mycophenolate mofetil (MMF) immunosuppression, except for 1 who was on tacrolimus and azathioprine (AZA). Of the 14 recipients, 11 had no episodes of acute rejection before steroid withdrawal. The remaining 3 had one or more acute rejection episodes. Of the 14 recipients, 10 (72%) currently remain off steroids (mean follow-up 18 months, range 5-51 months). However, 4 recipients have resumed steroids: 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 of the SPK recipients, in whom steroid withdrawal failed, has developed chronic kidney rejection and is now back on hemodialysis awaiting a retransplant. CONCLUSION:Steroid withdrawal is possible in up to 70% of pancreas transplant recipients. Further studies are necessary to define ideal candidates for steroid withdrawal. Based on the results of this analysis, we have launched a prospective, randomized trial of steroid withdrawal in pancreas transplant recipients.
journal_name
Clin Transplantjournal_title
Clinical transplantationauthors
Humar A,Parr E,Drangstveit MB,Kandaswamy R,Gruessner AC,Sutherland DEdoi
10.1034/j.1399-0012.2000.140114.xsubject
Has Abstractpub_date
2000-02-01 00:00:00pages
75-8issue
1eissn
0902-0063issn
1399-0012journal_volume
14pub_type
杂志文章abstract::Renal transplantation offers patients with end-stage renal disease the best opportunity for rehabilitation and long-term survival. However, there is a critical shortage of transplantable kidneys worldwide. This plays well into the hands of transplanters and entrepreneurs involved in commercial renal transplantation, p...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1995-08-01 00:00:00
abstract::Adverse symptoms of immunosuppressants (ASI) impact quality of life (QOL) in solid organ transplant recipients; however, standardized approaches for active ASI surveillance and intervention are lacking. While management is highly clinician dependent, clinician views remain largely unexplored. We surveyed Canadian Soci...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12940
更新日期:2017-05-01 00:00:00
abstract::Calciphylaxis is a rare vascular disorder characterized by calcification of arterioles which causes tissue inflammation and necrosis. It is associated with the metabolic disturbances seen in end-stage renal disease (ESRD) and has also been described in patients with cirrhosis with preserved kidney function. Characteri...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/ctr.13272
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:The purpose of the study was to assess the relationship between social support and immunosuppressant therapy adherence among adult renal transplant recipients. METHODS:A cross-sectional, survey design was employed. Mailed questionnaires were used to collect data from 81 recipients, and included the Immunosu...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2009.01060.x
更新日期:2010-05-01 00:00:00
abstract::Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (N...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/ctr.12832
更新日期:2016-10-01 00:00:00
abstract::Mycophenolic acid (MPA) dose reduction is associated with increased risk of rejection and graft loss in renal transplantation. This analysis investigated the impact of MPA dose changes with enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) in de novo heart transplant recipients. In a 12-month...
journal_title:Clinical transplantation
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1111/j.1399-0012.2008.00887.x
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:The role of advanced age live donors remains controversial because of decline in glomerular filtration rate and perceived increased risks of perioperative complications. METHODS:A retrospective review of all live donor transplants performed from January 2000 to December 2003. RESULTS:Seventy-eight live don...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2004.00328.x
更新日期:2005-10-01 00:00:00
abstract::Post-transplant outcome of kidney allografts depends on various factors, one of which may be the compatibility in volume between graft and recipient. However, previous studies adjusted the graft volume only for recipient's size. As the adjusted graft volume for donor's size would be substituted of nephron number more ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2011.01426.x
更新日期:2011-05-01 00:00:00
abstract::Distinct histopathologic changes occur in acute cellular rejection (ACR), antibody-mediated rejection (AMR), and biopsy-negative rejection (BNR). Cardiovascular magnetic resonance (CMR)-based myocardial tissue characterization can be used to quantify these changes. We assessed T1, T2, and extracellular volume fraction...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.13704
更新日期:2019-10-01 00:00:00
abstract::Acute allograft glomerulopathy (AAG) characterized by hypercellularity, enlargement of endothelial cells, infiltration of glomeruli by mononuclear cells and webs of PAS-positive material has been reported as an unusual but distinct form of acute rejection in kidney transplant recipients. We present a case of persisten...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1034/j.1399-0012.2001.0150s5002.x
更新日期:2001-01-01 00:00:00
abstract::The aim of this study was to determine whether patients with end-stage kidney disease (ESKD) on hemodialysis (HD) undergoing kidney transplant evaluation are at higher risk for colonic neoplasia than the general population. This is a retrospective cohort study of patients with ESKD who underwent a first screening colo...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12684
更新日期:2016-03-01 00:00:00
abstract::The majority of kidney transplant recipients die from cardiovascular events. Physical activity may be a modifiable risk factor for cardiovascular disease following transplant. The goal of our study was to examine adherence to a physical activity intervention following kidney transplant and its impact on metabolic para...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12553
更新日期:2015-06-01 00:00:00
abstract:UNLABELLED:Enteric-coated mycophenolate sodium (MPS) has been developed to help circumvent the upper gastrointestinal side-effects of mycophenolic acid by facilitating drug release in the small intestine. Many questions regarding the side-effect profile of MPS remain. Therefore, the purpose of this study is to review a...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2008.00820.x
更新日期:2008-09-01 00:00:00
abstract::We report a previously unrecognized late complication of allograft lung transplantation - persistent recurrent atelectasis of the transplanted lung. The patient developed sudden, severe respiratory distress about 2 yr after a right lung transplant, because of acute atelectasis of her transplanted lung. Multiple transb...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1034/j.1399-0012.2002.01121.x
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:End-stage renal disease is associated with illness-induced disruptions that challenge patients and their families to accommodate and adapt. However, the impact of patients' marital status on kidney transplant outcome has never been studied. This project, based on data from United States Renal Data System (US...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2006.00575.x
更新日期:2007-01-01 00:00:00
abstract::During liver transplant (LT), the release of vasoactive substances into the systemic circulation is associated with severe hemodynamic instability that is injurious to the recipient and/or the post-ischemic graft. Crystalloid flush with backward unclamping (CB) and portal blood flush with forward unclamping (PF) are t...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12130
更新日期:2013-07-01 00:00:00
abstract::There is paucity in the data examining the differences in mycophenolate mofetil (MMF) dosing and outcomes among pediatric kidney transplant recipients (PKTX) between races. The aims of this study were as follows (i) to assess whether higher doses of MMF are being utilized in African American (AA) PKTX (ii) to determin...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章
doi:10.1111/j.1399-0012.2010.01304.x
更新日期:2011-07-01 00:00:00
abstract::ABO-incompatibility is a major obstacle to expanding exiguous donor pools in adult liver transplantation, especially in countries where grafts from deceased donors are uncommon. We present our preliminary results of ABO-incompatible (ABO-I) adult living donor liver transplantation (LDLT) using a new, simple protocol. ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12060
更新日期:2013-03-01 00:00:00
abstract::A lack of research exploring post-transplant process optimization to reduce readmissions and increasing readmission rates at our center from 2009 to 2013 led to this study, aimed at assessing the effect of patient and process factors on 30-d readmission rates after kidney transplantation. This was a retrospective case...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12748
更新日期:2016-07-01 00:00:00
abstract::Portal vein thrombosis (PVT), a common complication of end stage liver disease, is no longer considered a definite contraindication for liver transplantation (LTx). The clinical decision to perform an LTx in the case of PVT depends on the degree of PVT and the experience of the surgeon. Eversion thromboendovenectomy w...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:10.1111/j.1399-0012.2006.00560.x
更新日期:2006-09-01 00:00:00
abstract::Renal transplantation was performed in a 24-yr-old woman with type AA systemic amyloidosis. Renal biopsy at 11 yr post-transplantation showed no amyloid recurrence, but the presence of mesangial proliferative glomerulonephritis and focal segmental glomerular sclerosis. Renal function was satisfactory with the exceptio...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:As the indications for liver transplantation broaden to include older and more critically ill patients, the likelihood of encountering unsuspected cardiovascular disease increases. PURPOSE:This study examined the frequency, type, and subsequent outcome of intra- and postoperative cardiovascular complication...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:To analyze the characteristics of tuberculosis (TB) in Southern Chinese renal transplant recipients, and summarize the corresponding experiences in diagnosis and management. METHOD:Retrospectively study 41 documented post-transplant TB cases out of the 2333 patients who received kidney transplantation in th...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2008.00878.x
更新日期:2008-11-01 00:00:00
abstract::Management of transplant patients receiving cyclosporine therapy is complicated by interpatient and intrapatient variability in pharmacokinetic parameters caused by the drug's unpredictable bioavailability. Cyclosporine, a highly lipophilic cyclic polypeptide, has recently been reformulated using a microemulsion deliv...
journal_title:Clinical transplantation
pub_type: 杂志文章,评审
doi:
更新日期:1996-08-01 00:00:00
abstract:BACKGROUND:Recent studies demonstrated safety and efficacy of heart transplantation (HT) from hepatitis C virus (HCV)-positive donors. We sought to evaluate the impact of HCV donor status on the outcomes of patients undergoing HT in the United States. METHODS:We analyzed a retrospective cohort of adult patients from t...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.14220
更新日期:2021-01-08 00:00:00
abstract::It is unclear whether a concomitant kidney transplant grants survival benefit to liver transplant (LT) candidates with renal dysfunction (RD). We retrospectively studied LT candidates without RD (n = 714) and LT candidates with RD who underwent either liver transplant alone (RD-LTA; n = 103) or simultaneous liver-kidn...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/ctr.12479
更新日期:2015-01-01 00:00:00
abstract::Temporary graft dysfunction with gas exchange abnormalities is a common finding during the postoperative course of a lung transplant and is often determined by the post-reimplantation syndrome. Supportive measures including oxygen by mask, inotropes, diuretics, and pulmonary vasodilators are usually effective in non-s...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-0012.2009.01050.x
更新日期:2009-09-01 00:00:00
abstract::The morphological characteristics of a kidney biopsy specimen taken 1 h after reperfusion of blood into the graft (1-h biopsy) during a cadaveric transplant operation were studied. The aim of the 1-h biopsy is to evaluate the pre-transplant risk factors for the delayed graft function, assess the renal function of the ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:There are limited published data concerning the effects of different immunosuppressive regimens on the development of polyomavirus (BKV) viremia. We examined the risk of developing BKV viremia in kidney transplant recipients receiving everolimus (EVR) or mycophenolic acid (MPA) as maintenance therapy. METHO...
journal_title:Clinical transplantation
pub_type: 临床试验,杂志文章
doi:10.1111/ctr.12151
更新日期:2013-07-01 00:00:00
abstract::We herein report the first case of immunosuppression-associated thrombotic microangiopathy (TMA) in which an extrarenal graft was primarily affected by the characteristic microvascular lesions. Although TMA is a well-known complication of cyclosporine (CSA) or tacrolimus therapy in renal and extrarenal (liver, heart, ...
journal_title:Clinical transplantation
pub_type: 杂志文章
doi:
更新日期:1998-12-01 00:00:00