TACROLIMUS THERAPY (FK-506) FOLLOWING SIM ULTANEOUS KIDNEY-PANCREAS TRANSPLANTATION

Tacrolimus has been effectively used as primary therapy in kidney and liver transplantation as well as in rescue therapy for steroid- and/or OKT III resistant rejection episodes. Due to the presumed effects of tacrolimus on glucose metabolism there has been concern about its use in simultaneous pancreas kidney transplantation. We investigated the e ffects of tacrolimus in simultaneous pancreas kidney transplantation i n cases where further therapy with cyclosporine was ineffective or con traindicated. In six out of seven patients treated with tacrolimus, cr eatinine levels decreased following conversion to tacrolimus. Serum cr eatinine determined as 3,8 +/- 1,2 mg/dl before conversion decreased t o 2,7 +/- 1,5 mg/dl (n = 7) three months thereafter and to 1,4 +/- 0,1 mg/dl (n = 3) at one year. One patient lost his pancreatic graft 4 mo nths after conversion due to a mycotic aneurysm. Before conversion, fa sting blood glucose was 147 +/- 33 mg/dl with three patients receiving insulin. Fasting blood glucose decreased to 100 +/- 19 mg/dl three mo nths thereafter with no patient receiving insulin and to 92 +/- 9 mg/d l at one year. In combined pancreas and kidney transplantation. A diab etogenic effect of tacrolimus was not clinically apparent.