Equivalent success of simultaneous pancreas kidney and solitary pancreas transplantation. A prospective trial of tacrolimus immunosuppression with percutaneous biopsy.
OBJECTIVE
This study was designed to evaluate the results of solitary pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous pancreas biopsy to diagnose rejection.


BACKGROUND
Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a pancreas atone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and biopsy techniques.


METHODS
Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients.


RESULTS
The 1-year pancreas graft survival rate of 90.1% in technically successful PA-FK patients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%).


CONCLUSIONS
Modern immunosuppression and biopsy techniques have improved the success of solitary pancreas transplantations to the point where outcome is now equivalent to that of SPKs.
Bartlett
S T
ST
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
Schweitzer
E J
EJ
Johnson
L B
LB
Kuo
P C
PC
Papadimitriou
J C
JC
Drachenberg
C B
CB
Klassen
D K
DK
Hoehn-Saric
E W
EW
Weir
M R
MR
Imbembo
A L
AL
D000328:Adult; D001707:Biopsy, Needle; D016572:Cyclosporine / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D016035:Pancreas Transplantation; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus