The use of intravenous tacrolimus and mycophenolate mofetil as induction and maintenance immunosuppression in simultaneous pancreas-kidney recipientswith previous transplants

Clinical trials using quadruple immunosuppression that include the combinat ion of tacrolimus (TAC) and mycophenolate mofetil (MMF) have been shown to reduce the incidence of acute rejection episodes in simultaneous pancreas-k idney (SPK) transplantation. In attempting to obtain a low rejection rate w ithout antibody induction therapy, we proceeded with the combination of TAC intravenous (i.v.), MMF, and steroids as induction therapy and as primary immunosuppression fur recipients with previous transplants. In this study, we analyzed 10 patients who received previous transplants, treated with low -dose TAC i.v. as induction therapy. Group A consisted of 6 patients with p revious transplants that underwent SPK and group B consisted of four recipi ents with previous SPK that underwent cadaveric kidney transplants, For gro up A, the previous transplants were: living related kidney (LRK) followed b y islet cell (IC) transplant (n = 2), RK transplant (n = 1). cadaver kidney (CAD) and IC transplant (n = 1). SPK (n = 1). and three previous CAD kidne y transplants (n = 1). In group A, all six kidneys were lost due to recurre nt diabetic nephropathy, IC possibly to rejection, and the pancreas due to thrombosis. In group B with previous SPK transplants. three recipients lost their kidney to chronic rejection and one to long-term use of a nephrotoxi c antibiotic. Currently, in all group A and B patients, the kidney and the pancreas are functioning, although patient in group A developed type 2 diab etes (normal fasting C-peptide). Two patients in group A developed three re jection episodes that responded to steroid treatment. The results indicate the TAC i.v. in combination with oral TAG. MMF, and steroids offer effectiv e induction therapy in patients with previous transplants.