The case for pancreas after kidney transplantation

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

Research output: Contribution to journalArticle

45 Scopus citations

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 (US)
Pages (from-to)447-453
Number of pages7
JournalClinical Transplantation
Volume23
Issue number4
DOIs
StatePublished - Aug 14 2009

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

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  • Cite this

    Fridell, J. A., Mangus, R. S., Hollinger, E. F., Taber, T. E., Goble, M. L., Mohler, E., Milgrom, M. L., & 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