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10 Year Experience Using a Steroid Free Three Drug Maintenance Immunosuppression Regimen for Pancreas Transplant Alone: Comparison of Induction With Rabbit Antithymocyte Globulin +/- Rituximab

J. Fridell,1 R. Mangus,1 J. Chen,2 M. Mujtaba,3 T. Taber,3 M. Goble,1 J. Powelson.1

1Surgery, Indiana University School of Medicine, Indianapolis, IN
2Pharmacy, Indiana University School of Medicine, Indianapolis, IN
3Medicine, Indiana University School of Medicine, Indianapolis, IN.

Meeting: 2015 American Transplant Congress

Abstract number: 231

Keywords: Immunosuppression, Induction therapy, Pancreas transplantation

Session Information

Date: Monday, May 4, 2015

Session Name: Concurrent Session: Optimizing Immunosuppression in Pancreas Transplantation

Session Time: 2:15pm-3:45pm

 Presentation Time: 3:03pm-3:15pm

Location: Room 119-B

Related Abstracts
  • Pancreas Transplantation Immunosuppression Induction With Rabbit Antithymocyte Globulin +/- Rituximab and Early Steroid Withdrawal: Experience With >500 Recipients
  • Forty-Seven Consecutive Simultaneous Liver-Kidney Transplants With Steroid Free Immunosuppression After Rabbit Antithymocyte Globulin Induction

Graft survival following pancreas transplant alone (PTA) is inferior to other pancreas transplants. Steroid elimination is appealing, but a two drug maintenance strategy may be inadequate. Additionally, although not enough to qualify for kidney Tx, recipients tend to have diabetic nephropathy and do not tolerate nephrotoxic medications. A three drug maintenance strategy permits more immunosuppression as well as an opportunity to use lower doses of the individual medications. For the last decade, we have used a three drug maintenance regimen for all PTAs. Methods: Induction consisted of five doses of rATG (1 mg/kg/dose). As of Oct 2007, a single dose of rituximab (150 mg/m2) was added on POD 1. Steroids were exclusively used as premedication for rATG. Maintenance consisted of tacrolimus (target trough 6-8 ng/ml), sirolimus (target trough 3-6 ng/ml) and mycophenolate mofetil (500 mg po bid). Results: From 2004 to 2014, 131 PTA were performed. Graft loss at 7 and 90 days were 5% and 6% and one year patient and graft survival were 97% and 90%. The Incidence of rejection was 5% and infection was 43% (CMV 11%). Comparing induction without (27%, median f/u102 months) to with (73%, median f/u 47 months) Rituximab, there was no significant difference in recipient demographics, although there were significantly more female donors (p=0.02) and donors had a higher BMI (p=0.05) in the rituximab group. There was no significant difference in 7 or 90 day graft loss, 1 year patient or graft survival or in the rate of rejection or infection.

Conclusion: Rabbit antithymocyte globulin induction and steroid withdrawal followed by a three drug immunosuppression regimen is an excellent strategy for pancreas transplant alone recipients. Preliminary results using rituximab as a component of induction appear promising.

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To cite this abstract in AMA style:

Fridell J, Mangus R, Chen J, Mujtaba M, Taber T, Goble M, Powelson J. 10 Year Experience Using a Steroid Free Three Drug Maintenance Immunosuppression Regimen for Pancreas Transplant Alone: Comparison of Induction With Rabbit Antithymocyte Globulin +/- Rituximab [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/10-year-experience-using-a-steroid-free-three-drug-maintenance-immunosuppression-regimen-for-pancreas-transplant-alone-comparison-of-induction-with-rabbit-antithymocyte-globulin-rituximab/. Accessed January 23, 2021.

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