From 9/1992 to 9/2003, 55 patients received a simultaneous pancreas-kidney transplantation (13 female, 42 male, mean age at transplantation 40.5 years (range 22-58 y.) in two different techniques: n=18 (bladder drainage) and n=38 (enteric drainage, incl. 1 retransplantation). Question was, if the introduction of a early steroid withdrawal (weaning after 3 months) will have impact on survival, rejections and cardiovascular complications.
Patients and Methods: Survival rates for patients (1/10 years) were 93/91%; for the pancreas 86/ 82% and for the kidney 9388%. 5 patients died during the mean follow- up time of 111,5 months (37-161 months). Patients recieved an ATG induction therapy on day 0 and 4, ciclosporine, azathioprin (16p./ 39p. since`96 MMF) and methylprednisolone 250 mg intraoperatively tapered down by half till 4 mg in week 4; from month 3 followed by a weaning for 4-6 weeks in patients without rejection episodes.
Results: Three of 50 patients were still on steroids (2,6 mg), on average patients were steroid-free 23 weeks after transplantation. Last follow-up mean blood glucose level was 79 mg%, creatinine 169 µmol/l,cholesterol 4,6 mmol/l and triglycerids 1,2 mmol/l (0,8-1,5). 26 patients were on medication (1-3) for hypertension. Significant differences were found only between the SPK and a control group (diabetics at dialysis) concerning LDL, triglycerides, plasma viscosity and fibrinogen (clear benefit for SPK). 7/55 patients had 11 rejection episodes during the observation period (20%) Early steroid-free immunosuppression is safe in SPK. Under C2 monitoring, treatment regimes with cyclosporine are showing less rejection episodes. cardiovascular risk is lower under SPK.