Author:
GRUESSNER ANGELIKA C.,SUTHERLAND DAVID E. R.,DUNN DAVID L.,NAJARIAN JOHN S.,HUMAR ABHI,KANDASWAMY RAJA,GRUESSNER RAINER W. G.
Abstract
Abstract. Pancreas after previous kidney (PAK) transplants are an attractive option for type 1 diabetic patients because of the short waiting time and use of living kidney donors. Factors associated with the increased success rate of PAK transplants in four immunosuppressive eras were analyzed. Between July 1, 1978, and April 30, 2000, 406 PAK transplants were performed in posturemic patients. Four immunosuppressive eras were analyzed: (1) the precyclosporine era, era 1 (n = 65; 16%); (2) the cyclosporine era, era 2 (n = 109; 27%); (3) the tacrolimus era with monoclonal or polyclonal antibody induction therapy, era 3 (n = 104; 26%); and (4) the tacrolimus era with monoclonal and polyclonal antibody induction therapy, era 4 (n = 128; 31%). Patient and graft survival, rejection, and technical failure rates were calculated. Patient survival rates have remained high over time, from 91% (era 1) to 96% (era 4) at 1 yr posttransplant. Pancreas graft survival rates with primary cadaver transplants have significantly increased, from 17% (era 1) to 81% (era 4) at 1 yr. The rate of graft loss from rejection has significantly decreased, from 78% (era 1) to 9% (era 4) at 1 yr. Results were best when donors and recipients were matched for at least one antigen per HLA locus. Kidney graft survival was higher in PAK transplant recipients compared with diabetic recipients of kidney transplants alone from the time of the kidney as well as the pancreas transplants. PAK recipients now enjoy >80% graft survival at 1 yr. This improvement in outcome results from better immunosuppression, good matching, and close posttransplant monitoring for rejection.
Publisher
American Society of Nephrology (ASN)
Subject
Nephrology,General Medicine
Reference16 articles.
1. Gruessner AC, Sutherland DER: Analyses of pancreas transplant outcomes for United States cases reported to the United Network for Organ Sharing (UNOS) and non-US cases reported to the International Pancreas Transplant Registry (IPTR). In: Clinical Transplants 1999, edited by Terasaki P, Cecka M, Los Angeles, UCLA Tissue Typing Laboratory, 2000, pp51 -69
2. SOLITARY PANCREAS TRANSPLANTATION FOR NONUREMIC PATIENTS WITH LABILE INSULIN-DEPENDENT DIABETES MELLITUS1
3. Simultaneous Pancreas-Kidney Transplantation From Live Donors
4. RECIPIENT RISK FACTORS HAVE AN IMPACT ON TECHNICAL FAILURE AND PATIENT AND GRAFT SURVIVAL RATES IN BLADDER-DRAINED PANCREAS TRANSPLANTS
Cited by
44 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献