Factors influencing outcome of simultaneous kidney and pancreas transplantation : a 23-year single-center clinical experience
Yamamoto, S ; Tufveson, G ; Wahlberg, J ; Berne, C ; Wadström, J and Biglarnia, A R LU
(2010)
In Transplantation Proceedings
42(10).
p.4197-4201
- Abstract
INTRODUCTION: Simultaneous kidney and pancreas transplantation (SKPT) has become an effective treatment for patients who have diabetes mellitus type I with advanced nephropathy. This study assesses the progress of the SKPT program at Uppsala University Hospital, Sweden, and evaluates prognostic factors for graft survival.
MATERIALS AND METHODS: Between February 1986 and September 2009, we performed 113 SKPT. The immunosuppression protocols changed over time and are defined as era 1, cyclosporine (CyA), atzathioprine (AZA) and steroids (C/A/S); era 2, C/A/S with antithymocyte globulin (ATG) induction (C/A/S/A); era 3, CyA, mycophenolate mofetic (MMF), steroids and ATG induction (C/M/S/A); era 4, tacrolimus (TAC), MMF, steroid, and... (More)
INTRODUCTION: Simultaneous kidney and pancreas transplantation (SKPT) has become an effective treatment for patients who have diabetes mellitus type I with advanced nephropathy. This study assesses the progress of the SKPT program at Uppsala University Hospital, Sweden, and evaluates prognostic factors for graft survival.
MATERIALS AND METHODS: Between February 1986 and September 2009, we performed 113 SKPT. The immunosuppression protocols changed over time and are defined as era 1, cyclosporine (CyA), atzathioprine (AZA) and steroids (C/A/S); era 2, C/A/S with antithymocyte globulin (ATG) induction (C/A/S/A); era 3, CyA, mycophenolate mofetic (MMF), steroids and ATG induction (C/M/S/A); era 4, tacrolimus (TAC), MMF, steroid, and ATG induction (T/M/S/A) and era 5, TAC, MMF, steroids and basiliximab induction (T/M/S/B). We analyzed donor/recipient/operative and postoperative variables to assess their influence on pancreas graft and patient survivals.
RESULTS: The overall 1-, 5-, and 10-year patient survivals were 95.5%, 84.1%, and 65.5%, respectively. The 1-, 5-, and 10-year overall pancreas graft survivals were 77.6%, 58.4%, and 48.4%. The 1-, 5-, and 10-year pancreas graft survivals in SKPT patients transplanted between October 1997 and September 2009. (T/M/S/A and T/M/S/B; eras 4 and 5) were 95.3%, 72.7%, and 63.1%, respectively, which was significantly better than those of patients transplanted between February 1986 and September 1997 (era, 1 through 3) (P < 0.01, P < 0.0001, respectively). The quadruple regimen with TAC and MMF (eras 4 and 5) decreased the incidence of acute rejection episodes compared with eras 1 through 3 (P < 0.0001). Basiliximab induction (T/M/S/B; era 5) reduced the CMV infection rate compared with eras 1 through 4 (P < 0.01). Multivariate analysis revealed that donor age (younger than 40 years), immunosuppressive regimen with TAC and MMF (eras 4 and 5), and absence of acute rejection episodes independently affected pancreas graft survival.
CONCLUSIONS: We demonstrate a superiority of the quadruple protocol with T/M/S/B for graft and patient survival with a decreased incidence of CMV infection after SKPT.
(Less)
- author
- Yamamoto, S
; Tufveson, G
; Wahlberg, J
; Berne, C
; Wadström, J
and Biglarnia, A R
LU
- publishing date
- 2010-12
- type
- Contribution to journal
- publication status
- published
- keywords
- Adult, Female, Graft Survival, Humans, Immunosuppressive Agents/administration & dosage, Kidney Transplantation, Male, Middle Aged, Pancreas Transplantation, Survival Analysis, Treatment Outcome
- in
- Transplantation Proceedings
- volume
- 42
- issue
- 10
- pages
- 4197 - 4201
- publisher
- Elsevier
- external identifiers
-
- pmid:21168663
- scopus:78650457603
- ISSN
- 0041-1345
- DOI
- 10.1016/j.transproceed.2010.09.076
- language
- English
- LU publication?
- no
- additional info
- Copyright © 2010 Elsevier Inc. All rights reserved.
- id
- 044f2b21-79c4-46c5-8634-f66696791056
- date added to LUP
- 2025-12-17 14:21:34
- date last changed
- 2025-12-19 02:25:41
@article{044f2b21-79c4-46c5-8634-f66696791056,
abstract = {{<p>INTRODUCTION: Simultaneous kidney and pancreas transplantation (SKPT) has become an effective treatment for patients who have diabetes mellitus type I with advanced nephropathy. This study assesses the progress of the SKPT program at Uppsala University Hospital, Sweden, and evaluates prognostic factors for graft survival.</p><p>MATERIALS AND METHODS: Between February 1986 and September 2009, we performed 113 SKPT. The immunosuppression protocols changed over time and are defined as era 1, cyclosporine (CyA), atzathioprine (AZA) and steroids (C/A/S); era 2, C/A/S with antithymocyte globulin (ATG) induction (C/A/S/A); era 3, CyA, mycophenolate mofetic (MMF), steroids and ATG induction (C/M/S/A); era 4, tacrolimus (TAC), MMF, steroid, and ATG induction (T/M/S/A) and era 5, TAC, MMF, steroids and basiliximab induction (T/M/S/B). We analyzed donor/recipient/operative and postoperative variables to assess their influence on pancreas graft and patient survivals.</p><p>RESULTS: The overall 1-, 5-, and 10-year patient survivals were 95.5%, 84.1%, and 65.5%, respectively. The 1-, 5-, and 10-year overall pancreas graft survivals were 77.6%, 58.4%, and 48.4%. The 1-, 5-, and 10-year pancreas graft survivals in SKPT patients transplanted between October 1997 and September 2009. (T/M/S/A and T/M/S/B; eras 4 and 5) were 95.3%, 72.7%, and 63.1%, respectively, which was significantly better than those of patients transplanted between February 1986 and September 1997 (era, 1 through 3) (P < 0.01, P < 0.0001, respectively). The quadruple regimen with TAC and MMF (eras 4 and 5) decreased the incidence of acute rejection episodes compared with eras 1 through 3 (P < 0.0001). Basiliximab induction (T/M/S/B; era 5) reduced the CMV infection rate compared with eras 1 through 4 (P < 0.01). Multivariate analysis revealed that donor age (younger than 40 years), immunosuppressive regimen with TAC and MMF (eras 4 and 5), and absence of acute rejection episodes independently affected pancreas graft survival.</p><p>CONCLUSIONS: We demonstrate a superiority of the quadruple protocol with T/M/S/B for graft and patient survival with a decreased incidence of CMV infection after SKPT.</p>}},
author = {{Yamamoto, S and Tufveson, G and Wahlberg, J and Berne, C and Wadström, J and Biglarnia, A R}},
issn = {{0041-1345}},
keywords = {{Adult; Female; Graft Survival; Humans; Immunosuppressive Agents/administration & dosage; Kidney Transplantation; Male; Middle Aged; Pancreas Transplantation; Survival Analysis; Treatment Outcome}},
language = {{eng}},
number = {{10}},
pages = {{4197--4201}},
publisher = {{Elsevier}},
series = {{Transplantation Proceedings}},
title = {{Factors influencing outcome of simultaneous kidney and pancreas transplantation : a 23-year single-center clinical experience}},
url = {{http://dx.doi.org/10.1016/j.transproceed.2010.09.076}},
doi = {{10.1016/j.transproceed.2010.09.076}},
volume = {{42}},
year = {{2010}},
}