Pancreas-after-kidney transplantation: an increasingly attractive alternative to simultaneous pancreas-kidney transplantation.
BACKGROUND
Historically, the clinical acceptability of pancreas-after-kidney (PAK) transplantation has been hampered by relatively high acute rejection rates and lower pancreas graft survival rates when compared with the more commonly performed simultaneous pancreas-kidney (SPK) transplantation. The purpose of this study was to compare PAK transplantation to SPK transplantation in the Thymoglobulin induction era.


METHODS
The authors reviewed all bladder-drained PAK (n=47) transplants receiving rabbit antithymocyte globulin induction from June 1998 to June 2002 and compared them with SPK (n=25) transplants during the same time period at their institution. The authors retrospectively studied data on demographics, patient survival, graft (pancreas and kidney) survival, complications, and biopsy-proven rejection episodes.


RESULTS
The actuarial 1-year patient survival was 93% for the PAK group versus 100% for the SPK group (P =not significant [NS]). The actuarial 1-year pancreas graft survival was 87% for the PAK group versus 92% for the SPK group (P =NS). Waiting time for PAK was significantly shorter than for SPK (6.3 +/- 5.2 vs. 16.2 + -13.7 months, P <0.05). Clinical acute rejection rates were similar in the two groups (4.3% for PAK vs. 4.0% for SPK). PAK recipients demonstrated a greater decline in renal function after transplantation compared with SPK. A multivariate analysis failed to elucidate the cause.


CONCLUSIONS
Newer immunosuppressive regimens allow PAK transplant patients to achieve immunologic outcomes similar to SPK transplant patients. Although the shorter waiting time and the ability to use living-donor kidneys make PAK an increasingly attractive alternative to SPK transplantation, its effect on renal allograft function deserves further attention.
Larson
Timothy S
TS
Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN 559805, USA.
Bohorquez
Humberto
H
Rea
David J
DJ
Nyberg
Scott L
SL
Prieto
Mikel
M
Sterioff
Sylvester
S
Textor
Stephen C
SC
Schwab
Thomas R
TR
Griffin
Matthew D
MD
Gloor
James M
JM
Kudva
Yogish C
YC
Kremers
Walter K
WK
Stegall
Mark D
MD
D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D016720:Pneumocystis Infections / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003404:Creatinine