Pancreas after kidney transplants in posturemic patients with type I diabetes mellitus

Pancreas after previous kidney (PAK) transplants are an attractive option f or type I diabetic patients because of the short waiting time and use of li ving kidney donors. Factors associated with the increased success rate of P AK transplants in four immunosuppressive eras were analyzed. Between July 1 , 1978, and April 30, 2000, 406 PAK transplants were performed in posturemi c patients. Four immunosuppressive eras were analyzed: (1) the precyclospor ine era, era 1 (n = 65, 16%); (2) the cyclosporine era, era 2 (n = 109; 27% ), (3) the tacrolimus era with monoclonal or polyclonal antibody induction therapy, era 3 (n = 104; 26%); and (4) the tacrolimus era with monoclonal a nd polyclonal antibody induction therapy, era 4 (n = 128; 31%). Patient and graft survival, rejection, and technical failure rates were calculated. Pa tient survival rates have remained high over time, from 91% (era 1) to 96% (era 4) at I yr posttransplant. Pancreas graft survival rates with primary cadaver transplants have significantly increased, from 17% (era 1) to 81% ( era 4) at 1 yr. The rate of graft loss from rejection has significantly dec reased, from 78% (era 1) to 9% (era 4) at I yr. Results were best when dono rs and recipients were matched for at least one antigen per HLA focus. Kidn ey graft survival was higher in PAK transplant recipients compared with dia betic recipients of kidney transplants alone from the time of the kidney as well as the pancreas transplants. PAK recipients now enjoy >80% graft surv ival at I yr. This improvement in outcome results from better immunosuppres sion, good matching, and close posttransplant monitoring for rejection.