Hosein Shokouh-Amiri

Simultaneous kidney-pancreas transplantation without antilymphocyte induction.

BACKGROUND The introduction of potent new immunosuppressive agents may allow simultaneous kidney-pancreas transplantation to be performed without antilymphocyte induction. METHODS We analyzed 30 simultaneous kidney-pancreas transplantations receiving tacrolimus, mycophenolate mofetil, and steroids without without antilymphocyte induction. Eighteen patients underwent pancreas transplantation with portal-enteric (P-E) drainage and the remaining 12 had systemic bladder (S-B) drainage. Target 12 hr trough tacrolimus levels for the first 3 months after simultaneous kidney-pancreas transplantation were 15-20 ng/ml. The oral mycophenolate mofetil dose was 2-3 g/day begun immediately posttransplant in two to four divided doses. Steroids were tapered according to protocol. RESULTS All patients experienced immediate function of both kidney and pancreas grafts. One-year actuarial patient, kidney, and pancreas graft survival rates are 93, 93, and 90%, respectively. Nine patients (30%) had a total of 13 rejection episodes (12 biopsy proven) including 4 within 2 weeks, 6 between 2 weeks and 3 months, and 3 beyond 3 months after simultaneous kidney-pancreas transplantation. Three rejection episodes were treated with steroids alone and 10 were treated with antilymphocyte therapy (5 OKT3 and 5 ATGAM). A total of seven patients (23%) received antilymphocyte therapy. Three patients (10%) had more than one rejection episode. Two pancreas grafts (7%) and one kidney graft (3%) were lost from rejection. Four patients (13%) developed cytomegalovirus infection, but none had tissue-invasive cytomegalovirus. At present, 22 surviving patients (81%) remain on triple immunosuppression with tacrolimus, mycophenolate mofetil, and prednisone with excellent dual graft function. CONCLUSION Tacrolimus, mycophenolate mofetil, and prednisone immunosuppression without without antilymphocyte induction is safe and effective after simultaneous kidney-pancreas transplantation.

Effects of Pancreas Transplantation on Secondary Complications of Diabetes

Diabetic nephropathy (DN) is the leading cause of end stage renal disease (ESRD) in the Western world, responsible for more than 44% of new ESRD cases in the United States.1 Type 2 diabetes is currently responsible for the large majority of diabetic ESRD patients.2 Among patients with type 1 diabetes, 25% to 35% ultimately develop severe DN and a similar risk is found by long-term survivors of type 2 diabetes.2 Despite the beneficial effects of antihypertensive agents, in slowing the rate of progression of overt diabetic nephropathy,3–5 the number of diabetic patients requiring renal replacement therapy is substantially and continuously increasing.1 Thus, any therapeutic intervention able to reduce the risk of ESRD in diabetes can provide benefits in terms of mortality, morbidity, quality of life of patients, and healthcare costs.