期刊
CELL TRANSPLANTATION
卷 15, 期 7, 页码 613-620出版社
SAGE PUBLICATIONS INC
DOI: 10.3727/000000006783981639
关键词
islet; transplantation; tacrolimus; neurotoxicity; beta-cell toxicity; function
资金
- NCRR NIH HHS [U42 RR016603] Funding Source: Medline
- NATIONAL CENTER FOR RESEARCH RESOURCES [U42RR016603] Funding Source: NIH RePORTER
Calcineurin inhibitors such as tacrolimus have well-recognized efficacy in organ transplantation but side effects of nephrotoxicity, neurotoxicity, and beta-cell toxicity that can be particularly detrimental in islet transplantation. Neuro- and nephrotoxicity have been demonstrated in multiple islet transplant recipients despite the relatively low serum maintenance levels typically used (3-5 ng/ml). We describe a single patient in whom symptoms and signs of neurotoxicity necessitated substitution of tacrolimus with mycophenolate mofetil (MMF), which resulted in complete symptom resolution over the subsequent 9 months. Concomitantly noted were an almost immediate improvement in glycemic control and an improved response to stimulation testing, suggesting remission of tacrolimus-induced beta-cell toxicity and insulin resistance. At 18 months post-switch, 30 months posttransplant, the patient remains insulin independent with good glycemic control. The goal to remove calcineurin inhibitors from regimens of islet transplantation is a worthy one.
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