title: Technical and immunologic progress in simultaneous pancreas-kidney transplantation.
abstract: 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.
authors.affiliation: Divisions of Transplantation, Nephrology, and Cardiology, Departments of Surgery and Medicine, Northwestern University Medical School, Chicago, Ill 60611, USA.
authors.forename: Dixon B
authors.initials: DB
authors.lastname: Kaufman
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Leventhal
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Gallon
authors.forename: Michele A
authors.initials: MA
authors.lastname: Parker
authors.forename: Michael D
authors.initials: MD
authors.lastname: Elliott
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Koffron
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Fryer
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
authors.forename: Frank P
authors.initials: FP
authors.lastname: Stuart
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents