PMID- 15814544
OWN - NLM
STAT- MEDLINE
DCOM- 20050901
LR  - 20131121
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 20 Suppl 2
DP  - 2005 May
TI  - Rejection after simultaneous pancreas-kidney transplantation.
PG  - ii11-7, ii62
AB  - BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation is an accepted 
      therapy for type 1 diabetic patients with end-stage renal disease. This study 
      analyses the occurrence of rejection episodes in patients undergoing SPK. 
      METHODS: The study population was obtained from 205 patients enrolled in the 
      Euro-SPK 001 study and randomized to receive tacrolimus- (n = 103) or cyclosporin 
      microemulsion (ME)-based (n = 102) immunosuppressive therapy. All patients 
      received concomitant antibody induction therapy, mycophenolate mofetil and 
      short-term corticosteroids. RESULTS: After 3 years of follow-up, rejection 
      episodes occurred in 41 patients receiving tacrolimus and in 51 patients 
      receiving cyclosporin-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 alone (88 vs 90%). Actuarial rejection-free 
      kidney and/or pancreas graft survival was similar for tacrolimus (54%) and 
      cyclosporin-ME (44%). Human leukocyte antigen (HLA) compatibility (P = 0.003) and 
      graft vessel extension (P = 0.000001) had a significant influence on 
      rejection-free graft survival. Also, rejection influenced pancreas graft survival 
      (P = 0.01), and pancreas graft loss due to rejection influenced patient survival 
      (P = 0.02). In the intent-to-treat analysis of early rejection, significantly 
      fewer tacrolimus- than cyclosporin-ME-treated patients had (i) more than one 
      rejection episode (11 out of 40 vs 24 out of 47; P = 0.03); (ii) first moderate 
      to severe rejection (one out of 40 vs 12 out of 47; P = 0.004); and (iii) 
      refractory rejection (two out of 40 vs 10 out of 47; P = 0.03). Pancreas survival 
      was lower in late rejectors (53%) than non-rejectors (86%; P = 0.002). Also, 
      serum creatinine was highest in late rejectors. CONCLUSION: Tacrolimus-based 
      immunosuppressive therapy demonstrates significant advantages over cyclosporin-ME 
      in terms of the severity of acute rejection in SPK transplant patients.
FAU - Arbogast, Helmut
AU  - Arbogast H
AD  - Department of Surgery, University of Munich, Grosshadern, Marchioninistr. 15, 
      D-81377 Munich, Germany. helmut.arbogast@med.uni-muenchen.de
FAU - Malaise, Jacques
AU  - Malaise J
FAU - Illner, Wolf-Dieter
AU  - Illner WD
FAU - Tarabichi, Anwar
AU  - Tarabichi A
FAU - Dieterle, Christoph
AU  - Dieterle C
FAU - Landgraf, Rudiger
AU  - Landgraf R
FAU - Land, Walter
AU  - Land W
CN  - Euro-SPK Study Group
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Emulsions)
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Biopsy
MH  - Cyclosporine/therapeutic use
MH  - Diabetes Mellitus, Type 1/complications/*surgery
MH  - Diabetic Nephropathies/complications/surgery
MH  - Disease-Free Survival
MH  - Drug Therapy, Combination
MH  - Emulsions
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Rejection/epidemiology/pathology/*prevention & control
MH  - Graft Survival
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Incidence
MH  - Kidney Failure, Chronic/etiology/*surgery
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - *Pancreas Transplantation
MH  - Postoperative Complications
MH  - Tacrolimus/therapeutic use
EDAT- 2005/04/09 09:00
MHDA- 2005/09/02 09:00
CRDT- 2005/04/09 09:00
PHST- 2005/04/09 09:00 [pubmed]
PHST- 2005/09/02 09:00 [medline]
PHST- 2005/04/09 09:00 [entrez]
AID - 20/suppl_2/ii11 [pii]
AID - 10.1093/ndt/gfh1077 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2005 May;20 Suppl 2:ii11-7, ii62. doi: 
      10.1093/ndt/gfh1077.