How Should Pancreas Transplant Rejection Be Treated?
Adult
Antilymphocyte Serum
/ adverse effects
Drug Therapy, Combination
Female
Graft Rejection
/ diagnosis
Graft Survival
/ drug effects
Humans
Immunocompromised Host
Immunosuppressive Agents
/ adverse effects
Male
Middle Aged
Opportunistic Infections
/ immunology
Pancreas Transplantation
/ adverse effects
Plasma Exchange
Risk Factors
Severity of Illness Index
Steroids
/ adverse effects
Time Factors
Treatment Outcome
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
pubmed:
25
6
2019
medline:
9
6
2020
entrez:
25
6
2019
Statut:
ppublish
Résumé
Limited published data exist to guide the treatment of pancreas transplant rejection. We reviewed the treatment and outcomes of 158 first episodes of biopsy-proven pancreas rejection between 1 January 1997 and 31 December 2016. Within each Banff grade of rejection, we compared response rates and long-term outcomes with steroids alone versus steroids plus antithymocyte globulin (ATG). Of 158 pancreas recipients with rejection, 65 were treated with steroids alone. Eighty-three percent of patients with grade I, 60% with grade II, and 33.33% with grade III rejection responded to treatment with steroids alone. Ninety-three patients were treated with steroids plus ATG. The response rates were 69% in grade I, 76% in grade II, and 73% in grade III. Response rates and graft survival were not different with grade I rejection treated with steroids alone versus steroids plus ATG. However, response rates and graft survival were significantly better with grade III rejection treated with the addition of ATG, and graft survival rates were significantly better with grade II rejection treated with the addition of ATG. Grade I pancreas rejection can usually be successfully treated with steroids alone, whereas grade II and III rejection should usually be treated with steroids plus ATG, as the addition of ATG improves both response rates and graft survival.
Sections du résumé
BACKGROUND
Limited published data exist to guide the treatment of pancreas transplant rejection.
METHODS
We reviewed the treatment and outcomes of 158 first episodes of biopsy-proven pancreas rejection between 1 January 1997 and 31 December 2016. Within each Banff grade of rejection, we compared response rates and long-term outcomes with steroids alone versus steroids plus antithymocyte globulin (ATG).
RESULTS
Of 158 pancreas recipients with rejection, 65 were treated with steroids alone. Eighty-three percent of patients with grade I, 60% with grade II, and 33.33% with grade III rejection responded to treatment with steroids alone. Ninety-three patients were treated with steroids plus ATG. The response rates were 69% in grade I, 76% in grade II, and 73% in grade III. Response rates and graft survival were not different with grade I rejection treated with steroids alone versus steroids plus ATG. However, response rates and graft survival were significantly better with grade III rejection treated with the addition of ATG, and graft survival rates were significantly better with grade II rejection treated with the addition of ATG.
CONCLUSIONS
Grade I pancreas rejection can usually be successfully treated with steroids alone, whereas grade II and III rejection should usually be treated with steroids plus ATG, as the addition of ATG improves both response rates and graft survival.
Identifiants
pubmed: 31233481
doi: 10.1097/TP.0000000000002694
doi:
Substances chimiques
Antilymphocyte Serum
0
Immunosuppressive Agents
0
Steroids
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM