W. Land

Calcineurin‐inhibitor avoidance in elderly renal allograft recipients using ATG and basiliximab combined with mycophenolate mofetil

In old recipients of renal allografts from old donors, benefits of calcineurin‐inhibitors (CNI) are curtailed by nephrotoxicity. Intending to improve the outcome of these recipients, we analyzed a CNI‐free immunosuppressive regimen consisting of anti‐thymocyte globulin (ATG), basiliximab, mycophenolate mofetil (MMF) and steroids. Kidney allograft recipients with low immunological risk (panel reactive antibodies <30%) were eligible for this study. Immunosuppression induction included ATG (4 mg/kg, day 0), basiliximab (20 mg, day 0 + 4) and steroids, followed by MMF (TL 2–6 μg/ml) and steroid maintenance treatment. Patient and graft survival rates respectively were 89.3% and 85.4% (12 months), and 86.6% and 76.8% (24 months). Delayed graft function occurred in 44.6%. S‐creatinine at 12 months was 1.85 ± 0.94 mg/dl. Thirty patients (53.6%) showed biopsy‐proven rejections (6x Banff 3, 13x Banff 4I and 16x Banff 4II), 77% of which were steroid‐sensitive, 23% required antibody treatment. After 12 months, 83% of the patients had an MMF‐based immunosuppression, 43% were CNI‐free. Cytomegalovirus (CMV) infections occurred in 28, tissue‐invasive disease in three patients. Despite acceptable renal graft survival and function in some of patients with marginal organs, high incidences of rejections and CMV infections suggest the feasibility of CNI‐avoidance using an MMF‐based protocol only in carefully selected patients.

164. Erfahrungen mit 26 segmentalen Pankreastransplantationen bei Typ 1 Diabetes mellitus

SummaryTwenty-six simultaneous pancreatic and kidney transplantations were performed in Type I diabetics in the Transplantation Center in Munich. Three patients received conventional immunosuppressive therapy and 23 received Ciclosporin and low-dosage steroids. In all cases we used the duct-obstruction technique with prolamine (Ethibloc ®). Graft function is currently 60% for the pancreas transplants and 80% for kidney. In our experience, combination segmental pancreatic and renal grafting in Ciclosporine-treated diabetics is associated with: (1) low mortality, (2) acceptable morbidity, (3) a low rate of immunological graft loss, and (4) a reasonable rate of functioning pancreatic grafts.ZusammenfassungAm Transplantationszentrum München wurden bisher 26 simultane Pankreasund Nierentransplantationen bei Typ 1 Diabetes mellitus durchgeführt. 3 Patienten erhielten als Immunsuppression Azathioprin und 23 Patienten Ciclosporin plus kleine Dosen Steroide. In allen Fällen erfolgte die Gangocclusion mit Ethibloc®. Die derzeitige Funktionsrate beträgt 60% für Pankreas und 80% für Niere. Aufgrund unserer Erfahrungen ist die segmentale Pankreastransplantation verbunden mit: 1. geringer Letalität, 2. akzeptabler Morbidität, 3. relativ geringer immunologischer Transplantatverlustrate und 4. relativ hoher Transplantatfunktionsrate.

304. Segmentale Pankreastransplantation unter Anwendung von Prolamine und Somatostatin

SummarySimultaneous transplantation of kidney and pancreas in juvenile diabetics (type I) with terminal kidney insufficiency is becoming increasing important. In addition to immunological problems, local complications occur due to the exocrine part of the organ. The combination of mechanical and hormonal blockade of the exocrine function was used for the first time in three of five transplanted patients: duct occlusion (Ethibloc) + somatostain (Srif 250/h) during the operation and in the first 4–10 postoperative days. The last patient has normal pancreas and kidney function for 10 months. The combination of mechanical and biochemical inhibition of the exocrine part of the pancreas improves a successful transplantation and the prevention of local complications.ZusammenfassungDie Simultantransplantation von Niere und Pankreas bei jevenilem Diabetikern (Typ I) mit terminater Niereninsuffizienz gewinnt an Bedeutung. Neben immunologischen Problemen gibt es lokale Komplikationen durch teilweise erhaltenes exokrines Restparenchym. Erstmalige Kombination mechanischer und hormoneller Blockade der exokrinen Funktion bei 3 von 5 Patienten. Pankreasgangocclusion (Ethibloc) + Somatostatin (Srif 250/h perioperativ und in den ersten 4–10 p.op. Tagen. Der zuletzt operierte Patient hat normale Pankreas- und Nierenfunktion seit 10 Monaten. Die Kombination mechanischer und biochemischer Inhibierung des exokrinen Pankreasanteiles scheint zur erfolgreichen Transplantation und zur Vermeidung lokaler Komplikationen zu verhelfen.