Prevention and treatment of rejection after simultaneous pancreas-kidney transplantation.
OBJECTIVE
To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney (SPK) transplantation.


METHODS
Seventeen patients underwent SPK transplantation from September 1999 to September 2003 were reviewed retrospectively. Immunosuppression was achieved by a triple drug regimen consisting of cyclosporine, mycophenolate mofteil (MMF), and steroids. Three patients were treated with anti-CD3 monoclone antibody (OKT3, 5 mg x d(-1)) for induction therapy for a mean period of 5-7 days. One patients received IL-2 receptor antibodies (daclizumab) in a dose of 1 mg x kg(-1) on the day of transplant and the 5th day posttransplant. One patient was treated with both OKT3 and daclizumab for induction.


RESULTS
No primary non-functionality of either kidney or pancreas occurred in this series of transplantations. Function of all the kidney grafts recovered within 2 to 4 days after transplantation. The level of serum creatinine was 94 +/- 11 micromol/L on the 7th day posttransplant. One patient experienced the accelerated rejection, resulting in the resection of the pancreas and kidney grafts because of the failure of conservative therapy. The incidence of the first rejection episodes at 3 months was 47.1% (8/17). Only the kidney was involved in 35.3% (6/17); and both the pancreas and kidney were involved in 11.8% (2/17). All these patients received a high-dose pulse of methylprednisone (0.5 g x d(-1)) for 3 days. OKT3 (0.5 mg x d(-1)) was administered for 7-10 days in two patients with both renal and pancreas rejection. All the grafts were successfully rescued.


CONCLUSIONS
Rejection, particularly acute rejection, is the major cause influencing graft function in SPK transplantation. Monitoring renal function and pancreas exocrine secretion, and reasonable application of immunosuppressants play important roles in the diagnosis and treatment of rejection.
Yang
Lei
L
Organ Transplantation Institute, First Affiliated Hospital, China Medical University, Shenyang 110001. yanglei72@medmail.com.cn
Liu
Yong-Feng
YF
Liu
Shu-Rong
SR
Wu
Gang
G
Zhang
Jia-Lin
JL
Meng
Yi-Man
YM
Shong
Shao-Wei
SW
Li
Gui-Chen
GC
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D003404:Creatinine / Q000097:blood; D000077561:Daclizumab; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D016035:Pancreas Transplantation; D011241:Prednisone / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; C008352:meprednisone; D003404:Creatinine; D000077561:Daclizumab; D011241:Prednisone