title: Low incidence of kidney rejection after simultaneous kidney-pancreas transplantation after antithymocyte globulin induction and in the absence of corticosteroids: results of a prospective pilot study in 28 consecutive cases.
abstract: BACKGROUND
  Recipients of simultaneous kidney-pancreas transplantation receive a combination of polyclonal antithymocyte globulin (ATG), cyclosporin or tacrolimus, mycophenolate mofetil (MMF) and corticosteroids (Cs). To avoid the side effects and adverse events associated with Cs, we investigated a new immunosuppressive regimen without Cs after simultaneous kidney-pancreas transplantation.
  
  
  METHODS
  A total of 28 consecutive patients who underwent simultaneous kidney-pancreas transplantation were included in this study. All patients received ATG, cyclosporin, and MMF.
  
  
  RESULTS
  All patients but one tolerated the ATG course well. MMF was definitively discontinued in three patients because of leukopenia. Cytomegalovirus infection was diagnosed in eight patients (28.5%). Only two patients (7%) required an antirejection treatment. Patient, kidney, and pancreas survival is currently 96.4, 96.4, and 75%, respectively.
  
  
  CONCLUSIONS
  The combination of ATG, cyclosporin, and MMF, without Cs, was well tolerated. The unexpectedly low (7%) incidence of acute kidney rejection observed suggests that Cs may partially interfere with the immunosuppressive effect of ATG.
authors.affiliation: Institut de Transplantation et de Recherche en Transplantation, Nantes University Hospital, France.
authors.forename: D
authors.initials: D
authors.lastname: Cantarovich
authors.forename: M
authors.initials: M
authors.lastname: Giral-Classe
authors.forename: M
authors.initials: M
authors.lastname: Hourmant
authors.forename: J
authors.initials: J
authors.lastname: Dantal
authors.forename: G
authors.initials: G
authors.lastname: Blancho
authors.forename: G
authors.initials: G
authors.lastname: Karam
authors.forename: J P
authors.initials: JP
authors.lastname: Soulillou
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation; D010865:Pilot Projects; D011300:Preoperative Care; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid