Simultaneous pancreas-kidney transplantation in the mycophenolate mofetil/tacrolimus era: Evolution from induction therapy with bladder drainage to noninduction therapy with enteric drainage
Db. Kaufman et al., Simultaneous pancreas-kidney transplantation in the mycophenolate mofetil/tacrolimus era: Evolution from induction therapy with bladder drainage to noninduction therapy with enteric drainage, SURGERY, 128(4), 2000, pp. 726-735
Background. In the past, enteric drainage or the omission of induction immu
notherapy has been shown to be predictive of suboptimal outcomes of simulta
neous pancreas-kidney (SPK) transplantation. We have reassessed the need fo
r bladder drainage and induction immunotherapy to optimize the outcome of S
PK transplantation.
Methods. One hundred consecutive recipients of SPK transplants who received
mycophenolate mofetil and tacrolimus immunosuppression were studied. The f
irst 50 recipients had bladder-drained pancreas allografts and received ind
uction immunotherapy. The results were compared with the next 50 recipients
who had enteric-drained pancreas allografts, which included a subgroup (n
= 17 patients) who were randomized to receive no induction immunotherapy.
Results. The 1-year actuarial patient, kidney, and pancreas survival rates
in the bladder-drainage group were 98.0 %, 94.0 %, and 94.0 %, respectively
. The 1-year actuarial patient, kidney and pancreas survival rates in the e
nteric-drainage group were 96.8 %, 96.8 %, and 89.4 %, respectively. In the
enteric-drainage group, the incidence of rejection at 1 year was 6.1 % in
recipients who received induction therapy versus 23.5% in recipients who di
d not receive induction, therapy. The average number of readmissions per re
cipient was 1.8 in the bladder-drainage group versus 0.9 in the enteric-dra
inage group.
Conclusions. Primary enteric drainage of the pancreas allograft in recipien
ts of SPK transplantation is the preferred surgical technique in the tacrol
imus/mycophenolate mofetil era.