Simultaneous pancreas-kidney transplantation in the mycophenolate mofetil/tacrolimus era: Evolution from induction therapy with bladder drainage to noninduction therapy with enteric drainage

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.