title: Simultaneous pancreas-kidney transplantation: analysis of rejection.
abstract: The 3-year data concerning the occurrence of rejection episodes (RE) are reported herein.
  
  
  METHODS
  Two hundred five simultaneous pancreas-kidney (SPK) transplantations were performed from May 1998 to September 2000, including 103 patients randomly assigned to tacrolimus (Tac) and 102 to cyclosporine microemulsion (CsA-ME). All patients received concomitant rATG induction therapy, mycophenolate mofetil (MMF), and short-term corticosteroids.
  
  
  RESULTS
  After a follow-up of 3 years, acute rejection episodes occurred in 41 patients receiving tacrolimus and in 51 patients receiving CsA ME. The majority of first rejection episodes in both groups occurred during the first 6 months (93% and 90%, respectively) and in most cases were treated with corticosteroids (88% and 90%). Actuarial rejection-free graft survival was not significantly different between the two groups (54% and 44% at 3 years posttransplant). In a multivariate analysis, HLA compatibility (P = .003) and graft vessel extension (P = .0005) had a significant influence on rejection-free survival. Rejection influenced pancreatic graft survival (P = .01) and pancreatic graft loss owing to rejection influenced patient survival (P = .02). In the intent-to-treat analysis of early rejection, first moderate-to-severe episodes (1 of 40 versus 12 of 47; P = .004) and refractory episodes (2 of 40 versus 10 of 47; P = .03) were significantly lower with tacrolimus than with CsA ME. Pancreatic graft survival was worse among late rejectors (53%) than nonrejectors (86%; P = .002). In addition, serum creatinine was highest in late rejectors. In conclusion, Tac-based immunosuppressive therapy shows advantages over CsA ME in terms of the severity of acute rejection episodes among patients undergoing SPK transplantation.
authors.affiliation: EUROSPK Central Office, Brussels, Belgium. jacques.malaise@chir.ucl.ac.be
authors.forename: J
authors.initials: J
authors.lastname: Malaise
authors.forename: H
authors.initials: H
authors.lastname: Arbogast
authors.forename: W D
authors.initials: WD
authors.lastname: Illner
authors.forename: A
authors.initials: A
authors.lastname: Tarabichi
authors.forename: C
authors.initials: C
authors.lastname: Dieterle
authors.forename: R
authors.initials: R
authors.lastname: Landgraf
authors.forename: W
authors.initials: W
authors.lastname: Land
authors.forename: D
authors.initials: D
authors.lastname: Van Ophem
authors.forename: J P
authors.initials: JP
authors.lastname: Squifflet
mesh_terms: D000208:Acute Disease; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology; D016035:Pancreas Transplantation / Q000276:immunology* / Q000502:physiology
chemical_list: D007166:Immunosuppressive Agents