The case for pancreas after kidney transplantation

Jonathan A. Fridell, Richard Mangus, Edward F. Hollinger, Tim Taber, Michelle L. Goble, Elaine Mohler, Martin L. Milgrom, John A. Powelson

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti-thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One-yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus-based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.

Original languageEnglish
Pages (from-to)447-453
Number of pages7
JournalClinical Transplantation
Volume23
Issue number4
DOIs
StatePublished - 2009

Fingerprint

Kidney Transplantation
Pancreas
Kidney
Immunosuppression
Transplants
Tacrolimus
Graft Survival
Allografts
Drainage
Steroids
Mycophenolic Acid
Pancreas Transplantation
Antilymphocyte Serum
Survival
Living Donors
Globulins
Sirolimus
Thymocytes

Keywords

  • Immunosuppression
  • Pancreas after kidney transplantation
  • Pancreas transplantation
  • Rabbit anti-thymocyte globulin
  • Simultaneous kidney and pancreas transplantation
  • Survival
  • Transplant outcomes

ASJC Scopus subject areas

  • Transplantation

Cite this

Fridell, J. A., Mangus, R., Hollinger, E. F., Taber, T., Goble, M. L., Mohler, E., ... Powelson, J. A. (2009). The case for pancreas after kidney transplantation. Clinical Transplantation, 23(4), 447-453. https://doi.org/10.1111/j.1399-0012.2009.00996.x

The case for pancreas after kidney transplantation. / Fridell, Jonathan A.; Mangus, Richard; Hollinger, Edward F.; Taber, Tim; Goble, Michelle L.; Mohler, Elaine; Milgrom, Martin L.; Powelson, John A.

In: Clinical Transplantation, Vol. 23, No. 4, 2009, p. 447-453.

Research output: Contribution to journalArticle

Fridell, JA, Mangus, R, Hollinger, EF, Taber, T, Goble, ML, Mohler, E, Milgrom, ML & Powelson, JA 2009, 'The case for pancreas after kidney transplantation', Clinical Transplantation, vol. 23, no. 4, pp. 447-453. https://doi.org/10.1111/j.1399-0012.2009.00996.x
Fridell, Jonathan A. ; Mangus, Richard ; Hollinger, Edward F. ; Taber, Tim ; Goble, Michelle L. ; Mohler, Elaine ; Milgrom, Martin L. ; Powelson, John A. / The case for pancreas after kidney transplantation. In: Clinical Transplantation. 2009 ; Vol. 23, No. 4. pp. 447-453.
@article{903664b7a76e4a2687116b92b3f415ef,
title = "The case for pancreas after kidney transplantation",
abstract = "Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti-thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30{\%}) and SPK 142 (70{\%}). One-yr patient survival was PAK 98{\%} and SPK 95{\%} (p = 0.44) and pancreas graft survival was PAK 95{\%} and SPK 90{\%} (p = 0.28). Acute cellular rejection was uncommon with 2{\%} requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus-based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.",
keywords = "Immunosuppression, Pancreas after kidney transplantation, Pancreas transplantation, Rabbit anti-thymocyte globulin, Simultaneous kidney and pancreas transplantation, Survival, Transplant outcomes",
author = "Fridell, {Jonathan A.} and Richard Mangus and Hollinger, {Edward F.} and Tim Taber and Goble, {Michelle L.} and Elaine Mohler and Milgrom, {Martin L.} and Powelson, {John A.}",
year = "2009",
doi = "10.1111/j.1399-0012.2009.00996.x",
language = "English",
volume = "23",
pages = "447--453",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - The case for pancreas after kidney transplantation

AU - Fridell, Jonathan A.

AU - Mangus, Richard

AU - Hollinger, Edward F.

AU - Taber, Tim

AU - Goble, Michelle L.

AU - Mohler, Elaine

AU - Milgrom, Martin L.

AU - Powelson, John A.

PY - 2009

Y1 - 2009

N2 - Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti-thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One-yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus-based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.

AB - Pancreas after kidney (PAK) transplantation has historically demonstrated inferior pancreas allograft survival compared to simultaneous pancreas and kidney (SPK) transplantation. Under our current immunosuppression protocol, we have noted excellent outcomes and rare immunological graft loss. The goal of this study was to compare pancreas allograft survival in PAK and SPK recipients using this regimen. This was a single center retrospective review of all SPK and PAK transplants performed between January 2003 and November 2007. All transplants were performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included induction with rabbit anti-thymocyte globulin (thymoglobulin), early steroid withdrawal, and maintenance with tacrolimus and sirolimus or mycophenolate mofetil. Study end points included graft and patient survival and immunosuppression related complications. Transplants included PAK 61 (30%) and SPK 142 (70%). One-yr patient survival was PAK 98% and SPK 95% (p = 0.44) and pancreas graft survival was PAK 95% and SPK 90% (p = 0.28). Acute cellular rejection was uncommon with 2% requiring treatment in each group. Survival for PAK using thymoglobulin induction, early steroid withdrawal and tacrolimus-based immunosuppression is at least comparable to SPK and should be pursued in the recipient with a potential living donor.

KW - Immunosuppression

KW - Pancreas after kidney transplantation

KW - Pancreas transplantation

KW - Rabbit anti-thymocyte globulin

KW - Simultaneous kidney and pancreas transplantation

KW - Survival

KW - Transplant outcomes

UR - http://www.scopus.com/inward/record.url?scp=68349131580&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68349131580&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2009.00996.x

DO - 10.1111/j.1399-0012.2009.00996.x

M3 - Article

VL - 23

SP - 447

EP - 453

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 4

ER -