Mycophenolate mofetil and tacrolimus as primary maintenance immunosuppression in simultaneous pancreas-kidney transplantation - Initial experience in50 consecutive cases

Background. The current study examines the use of mycophenolate mofetil (MM F) and tacrolimus as primary immunosuppression in simultaneous pancreas-kid ney (SPK) transplantation. In addition, analyses of the rates of conversion from one immunosuppressive agent to another, and its subsequent consequenc es with respect to outcomes were determined. Quality of graft function, inf ections, and effect on preexisting essential hypertension are also describe d. Methods. Immunosuppression consisted of quadruple therapy with antithymocyt e globulin induction, tacrolimus, MMF, and prednisone. Patient and graft su rvival and rejection rates in 50 consecutive SPK recipients, followed for a minimum of 3 months and a mean of 14 months (range: 3-34 months), are desc ribed. Results. Thirty-nine of 50 (78%) patients tolerated the MMF/tacrolimus comb ination long-term (mean duration of follow-up: 14+/-7 months). Nine of 50 p atients (18%) were converted to Neoral(R), and 4 patients were converted to azathioprine as a substitute for MMF. The 2-year actuarial patient, kidney , and pancreas survival rates were 97.7%, 93.3%, and 90.0%, respectively. A t 6 months after transplant, the overall incidence of acute rejection was 1 6%. There was a statistically significant (P less than or equal to 0.04, Co x-Mantel test) difference in the rate of rejection associated with conversi on to Neoral(R). The incidence of rejection 6 months after transplant in th e group maintained on MMF/tacrolimus was 10.2% vs. 44.4% in the group conve rted to Neoral(R) (P less than or equal to 0.04, Cox-Mantel test). Overall, the 1-year actuarial cumulative incidence of tissue-invasive cytomegalovir us disease was 6.6%. There were no cases of fungal infections or post-trans plant lymphoproliferative disorders. One patient developed Kaposi's sarcoma 10 months after transplant. With respect to hypertensive disease, 60% (12/ 20) of the patients who required pharmacologic control of blood pressure be fore transplant were off all antihypertensive medications at 1 year after t ransplant. An additional 20% (4/20) of patients had a reduction in the numb er of medications required to control blood pressure at 1 year after transp lant. Conclusions. We conclude that the combination of MMF and tacrolimus as prim ary immunosuppression for SPK transplantation results in excellent patient and graft survival rates, a very low rate of acute rejection, and low rates of infection and malignancy.