MYCOPHENOLATE-MOFETIL IN PANCREAS TRANSPLANTATION

Background. Mycophenolate mofetil (MMF) has been shown to decrease the incidence of acute rejection episodes after kidney transplantation. T he use of MMF along with tacrolimus for greater than or equal to 1 yea r after pancreas transplantation has not been studied in a large singl e-center analysis. Methods. Between July 1, 1995 and June 30, 1997, bo th MMF and tacrolimus were given to 120 pancreas transplant recipients . By category, 61 underwent simultaneous pancreas-kidney transplantati on (SPR); 44 underwent pancreas transplantation after previous kidney transplantation (PAK); and 15 underwent pancreas transplantation alone (PTA). By donor source, 86% of the grafts were from a cadaver, and 14 % were from a living-related donor, Induction therapy was with MMF, ta crolimus, prednisone, and antithymocyte globulin (n=109) or OKT3 (n=2) . Until oral intake was resumed, recipients initially received intrave nous azathioprine. Side effects were as follows: gastrointestinal (GI) toxicity in 53% of recipients receiving combined MMF and tacrolimus t herapy; bone marrow toxicity in 24% of recipients receiving MMF alone; nephrotoxicity in 18% and neurotoxicity in 11% of pair analysis to co mpare outcome in MMF versus azathioprine recipients, using the databas e of the International Pancreas Transplant Registry, Matching criteria included transplantation category, transplantation number, recipient and donor age, duct management, HLA typing and transplantation year. R esults. One-year patient survival rates were 98% for SPK, 98% for PAK, and 100% for PTA (P=NS), For SPK recipients, 1-year pancreas graft su rvival rates were 86% with MMF versus 79% with azathioprine (P=NS): ki dney graft survival rates were 96% with MMF versus 86% with azathiopri ne (P=NS). The incidence of first rejection episodes at 1 year was sig nificantly lower for MMF recipients (15% with MMF versus 43% with azat hioprine) (P=0.0003). For recipients of solitary pancreas transplants (PTA and PAK), we found no difference in graft survival rates between MMF and azathioprine. The conversion rate from MMF to azathioprine at 1 year was 14% for SPK recipients, 26% for PAK, and 39% for PTA (P<0.0 07). The most common reason for conversion was GI toxicity, in particu lar for nonuremic (PTA) or posturemic (PAK) recipients, The rates of p osttransplant infection and lymphoproliferative disease were low for r ecipients on MMF and tacrolimus. Conclusions. The combination of MMF a nd tacrolimus after pancreas transplantation is highly effective and s afe. For SPR recipients, the incidence of acute reversible rejection e pisodes was significantly lower with MMF than with azathioprine. The c onversion rate from MMF to azathioprine because of GI toxicity was low est for SPK and highest for PTA recipients.