Technical and immunologic progress in simultaneous pancreas-kidney transplantation.
BACKGROUND
During the past few years the use of new immunosuppressants and refinements in surgical technique of simultaneous pancreas-kidney (SPK) transplantation have resulted in markedly improved outcomes. This is a retrospective study of 208 SPK transplants performed at Northwestern University, demonstrating the advances made at a single center that are reflective of the field at large.


METHODS
An 8.5-year time span was split into 4 distinct eras marking sequential changes in immunosuppression and surgical technique that ensued. SPK transplant outcomes of patient and graft survival and rejection rates were compared. Also examined were end points related to the changing risk profile of the recipients, as well as quality of allograft function and rates of rehospitalizations.


RESULTS
Recipients receiving tacrolimus/mycophenolate mofetil-based immunosuppression had patient, kidney, and pancreas survival rates significantly higher than those of earlier cohorts. The elimination of corticosteroids did not reduce survival rates or increase rejection risk. The use of pancreatic exocrine enteric drainage technique over bladder drainage reduced rehospitalizations.


CONCLUSIONS
Advances in immunosuppression management combined with technical refinements have made SPK transplantation a safer and more effective treatment option for the diabetic, uremic patient.
Kaufman
Dixon B
DB
Divisions of Transplantation, Nephrology, and Cardiology, Departments of Surgery and Medicine, Northwestern University Medical School, Chicago, Ill 60611, USA.
Leventhal
Joseph R
JR
Gallon
Lorenzo G
LG
Parker
Michele A
MA
Elliott
Michael D
MD
Gheorghiade
Mihai
M
Koffron
Alan J
AJ
Fryer
Jonathan P
JP
Abecassis
Michael M
MM
Stuart
Frank P
FP
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000145:classification / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D044469:Racial Groups; D012189:Retrospective Studies; D013997:Time Factors
D007166:Immunosuppressive Agents