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Immunosuppression Post-Transplant Not Always Best

Type of follow-up treatment for islet transplantation depends on kidney function

THURSDAY, May 17 (HealthDay News) -- In patients with type 1 diabetes who receive islet transplantation, use of the Edmonton immunosuppressive protocol (tacrolimus-sirolimus association) is only suitable for those with normal kidney function, while other alternatives should be considered for those with kidney disease, according to a report published in the May issue of Diabetes Care.

Paola Maffi, M.D., Ph.D., of the San Raffaele Scientific Institute in Milan, Italy, and colleagues conducted a study of 19 patients with type 1 diabetes who underwent islet transplantation and received immunosuppressive therapy. To assess the results, the investigators looked at serum creatinine, creatinine clearance and 24-hour urinary protein excretion over a follow-up period of 339 patient-months.

While 17 patients had normal range serum creatinine levels immediately after islet transplantation, two had increased levels and in time their condition worsened to end-stage renal disease, despite withdrawal of immunosuppressive drugs. For patients with normal baseline creatinine clearance, levels were maintained after transplantation, but for those with decreased levels prior to surgery, greater decreases were observed and these patients progressed to end-stage renal disease.

"In type 1 diabetic patients receiving islet transplantation alone, the association of tacrolimus and sirolimus should be used only in patients with normal kidney function. Alternative options for immunosuppressive treatment should be considered for patients with even a mild decrease of kidney function," the authors conclude.

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