USE OF TACROLIMUS ELIMINATES ACUTE REJECTION AS A MAJOR COMPLICATION FOLLOWING SIMULTANEOUS KIDNEY AND PANCREAS TRANSPLANTATION

This retrospective study illustrates the efficacy of tacrolimus-based immunosuppression following simultaneous kidney and pancreas transplan tation. Between March 1995 and December 1996, 24 simultaneous kidney a nd pancreas transplant recipients received tacrolimus-based maintenanc e immunosuppression. All patients received sequential therapy with an antilymphocyte agent, azathioprine, prednisone and tacrolimus. The dos e of tacrolimus was adjusted to achieve a whole blood trough level of 8-15 ng/mL (IMx). The mean follow-up was 25 months with a median of 26 months (range 12-33 months). A rise in serum creatinine of > 20% over baseline was investigated with a renal biopsy, after mechanical cause s for renal dysfunction had been excluded. Mean serum creatinine conce ntrations at 3, 6, 12, 18 and 24 months post-transplantation were 1.1, 1.2, 1.3, 1.3 and 1.3 mg/dL respectively. The blood glucose concentra tions at the corresponding time period were 115, 94, 95, 93 and 95 mg/ dL. Four pancreas allografts were lost (three in the immediate post-tr ansplant period due to thrombosis, and one following iliac artery repa ir for aneurysm). Transient hyperglycemia requiring treatment was seen in 3 patients. There were four (17%) acute rejection episodes - one o f the pancreas allograft alone and three involving the kidney. At a me an follow-up of 25 months, the patient survival and renal allograft su rvival were 100%, with pancreas allograft survival rate of 78.4% (Kapl an-Meier analysis). Nine (37.5%) patients had evidence of tacrolimus t oxicity on renal histology. In conclusion, tacrolimus-based maintenanc e immunosuppression is associated with stable renal and pancreas allog raft function, with freedom from acute rejection in 83% of patients.