Calcineurins and steroids have been the foundation in immunosuppression regimens for pancreas transplants since the introduction of the procedure. Although steroids have several side effects such as hypertension, osteoporosis, and gastric ulcerations while calcineurins can cause hyperglycemia, hirsutism, and hyperlipidemia, these immunosuppressive regimens in combination have resulted in a significant reduction in acute rejection rates. In recent reports, steroid withdrawal or avoidance in kidney transplantation has been associated with excellent rejection-free graft survival, particularly when induction therapy is used. Although there is no clear evidence of the ability of steroid-free protocols in pancreas transplants to achieve success, early results in pancreas kidney patients are extremely encouraging. With more studies, the use of nontoxic immunosuppressants will be possible and will result in further improvement in patients' quality of life after pancreas transplantation.
University of Tennessee, Memphis, Tennessee, USA.
Correspondence to Lillian W. Gaber, MD, Department of Pathology, Transplant Division, University of Tennessee, Memphis, 930 Madison Avenue, 5th Floor, Memphis, TN 38103, USA; e-mail: firstname.lastname@example.org