Simultaneous kidney-pancreas transplantation without antilymphocyte induction

Background. The introduction of potent new immunosuppressive agents may all ow simultaneous kidney-pancreas transplantation to be performed without ant ilymphocyte induction. Methods. We analyzed 30 simultaneous kidney-pancreas transplantations recei ving tacrolimus, mycophenolate mofetil, and steroids without without anti- lymphocyte induction. Eighteen patients underwent pancreas transplantation with portal-enteric (P-E) drainage and the remaining 12 had systemic bladde r (S-B) drainage. Target 12 hr trough tacrolimus levels for the first 3 mon ths after simultaneous kidney-pancreas transplantation were 15-20 ng/ml, Th e oral mycophenolate mofetil dose was 2-3 g/day begun immediately posttrans plant in two to four divided doses. Steroids were tapered according to prot ocol. Results. All patients experienced immediate function of both kidney and pan creas grafts. One-year actuarial patient, kidney, and pancreas graft surviv al rates are 93, 93, and 90%, respectively, Nine patients (30%) had a total of 13 rejection episodes (12 biopsy proven) including 4 within 2 weeks, 6 between 2 weeks and 3 months, and 3 beyond 3 months after simultaneous kidn ey-pancreas transplantation. Three rejection episodes were treated with ste roids alone and 10 were treated with antilymphocyte therapy (5 OKT3 and 5 A TGAM). A total of seven patients (23%) received antilymphocyte therapy. Thr ee patients (10%) had more than: one rejection episode. Two pancreas grafts (7%) and one kidney graft (3%) were lost from rejection. Four patients (13 %) developed cytomegalovirus infection,but none had tissue-invasive cytomeg alovirus, At present, 22 surviving patients (81%) remain on triple immnnosu ppression with tacrolimus, mycophenolate mofetil, and prednisone with excel lent dual graft function. Conclusion. Tacrolimus, myeophenolate mofetil, and prednisone immunosuppres sion without without antilymphocyte induction is safe and effective after s imultaneous kidney-pancreas transplantation.