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Randomized Controlled Trial
. 2020 Jun;20(6):1679-1690.
doi: 10.1111/ajt.15809. Epub 2020 Feb 28.

Tacrolimus- versus sirolimus-based immunosuppression after simultaneous pancreas and kidney transplantation: 5-year results of a randomized trial

Diego Cantarovich  1   2 , Delphine Kervella  1 , Georges Karam  2 , Jacques Dantal  1   2 , Gilles Blancho  1   2 , Magali Giral  1   2 , Claire Garandeau  2 , Aurélie Houzet  1   2 , Simon Ville  1   2 , Julien Branchereau  1   2 , Florent Delbos  3 , Cécile Guillot-Gueguen  2 , Christelle Volteau  4 , Maxime Leroy  4 , Karine Renaudin  1   5 , Jean-Paul Soulillou  1 , Maryvonne Hourmant  2
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Free article
Randomized Controlled Trial

Tacrolimus- versus sirolimus-based immunosuppression after simultaneous pancreas and kidney transplantation: 5-year results of a randomized trial

Diego Cantarovich et al. Am J Transplant. 2020 Jun.
Free article

Abstract

Tacrolimus, the cornerstone immunosuppression after simultaneous pancreas and -kidney (SPK) transplantation, may exert nephrotoxic and diabetogenic effects. We therefore prospectively compared in an open-label, randomized, monocentric, 5-year follow-up study, a tacrolimus- and a sirolimus-based immunosuppressive regimen. Randomization using the block method allowing a blind allocation was done at the time of surgery. All patients received anti-thymocyte globulin and maintenance therapy with tacrolimus, mycophenolate mofetil, and steroids. At month 3, tacrolimus was continued or replaced by sirolimus. The primary endpoint was kidney and pancreas graft survival at 1 and 5 years. Fifty patients were included in the final analysis in each group. At 1 year, differences for kidney and pancreas graft survival between sirolimus and tacrolimus were 0% (90% confidence interval -4.61% to 4.61%) and 6% (90% confidence interval -6.32% to 18.32%), respectively. There was no difference in renal and pancreas graft survival at 5 years. Thirty-four patients (68%) in the sirolimus group vs three (6%) in the tacrolimus group needed definitive withdrawal of the study drug. Despite noninferiority of sirolimus compared to tacrolimus for kidney and pancreas graft survival, the high rate of sirolimus discontinuation does not favor its use as cornerstone therapy after SPK transplantation (NCT00693446).

Keywords: clinical research; clinical trial; immune modulation; immunosuppressant - mechanistic target of rapamycin: sirolimus; immunosuppression; pancreas; practice; simultaneous pancreas and kidney transplantation.

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References

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