Worldwide, a total of more than 1,000 pancreas transplantations per year are performed, mostly as simultaneous pancreas-kidney transplantations (SPKs). More than 90% of all SPKs are carried out using the bladder drainage technique. However, long-term problems of the bladder drainage technique require enteric conversion in 10–20%. Very good results can be achieved using primarily the enteric drainage as well. Furthermore, the pancreas graft can be drained via the superior mesenteric vein. We describe the change of surgical technique in SPK at the Bochum transplantation center.
Using conventional quadruple induction therapy with CSA/ AZA/PRD/antibodies (ATG/OKT3, 10–14 days), the incidence of acute rejection episodes after simultaneous pancreas/kidney transplantation (SPK) reaches 56–85%. Here we describe the 6-month follow-up results using different immunosuppressive protocols. 38 patients (group I) received CSA/AZA/ PRD/10 days ATG. ATG and PRD were given prior to pancreas reperfusion. 32 patients (group II) were treated with TAC/ MMF/PRD/single-shot ATG, 16 patients (group III) with CSA/ MMF/PRD/single-shot ATG. ATG, MMF, PRD and TAC/CSA were given prior to surgery. The incidence of rejections period in the different groups was 34.2%, 18.8% and 18.8%, respectively. No pancreas graft was lost for immunological reasons. It seems to be possible to significantly reduce the incidence of rejection period after SPK. In combination with MMF, TAC and CSA appear to be equally efficacious. It seems that the long-term antibody induction therapy is no longer required.
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