Elsevier

Transplantation Proceedings

Volume 38, Issue 6, July–August 2006, Pages 1933-1936
Transplantation Proceedings

Pancreas transplantation
No Induction Versus Anti-IL2R Induction Therapy in Simultaneous Kidney Pancreas Transplantation: A Comparative Analysis

https://doi.org/10.1016/j.transproceed.2006.06.072Get rights and content

Abstract

The optimal immunosuppressive regimen for simultaneous kidney pancreas transplantation (SKPT) is still not established. We conducted a study to compare the safety and efficacy of no induction versus anti-IL-2 receptor induction protocols in SKPT recipients receiving the same maintenance regimen.

Methods

Sixty-three SKPT recipients were divided into two groups: no induction group (n = 42) and anti-IL-2 receptor induction group (n = 21). All patients were maintained on tacrolimus, mycophenolate mofetil, and prednisone. Primary endpoints were 1-year acute rejection incidence and patient and graft survivals.

Results

Demographic characteristics were similar between the groups. Acute rejection incidence at 1 year was equal in both groups (28.6%). Kidney and pancreas allograft survival in the no induction group were 78.6% and 76.2%, and in the anti-IL-2R induction group, 81% and 71.4%, respectively (P = NS). Patient survival was also similar: 83.3% in the no induction versus 85.7% in the anti-IL-2R induction group. Deaths due to sepsis were higher in the anti-IL-2R induction group, albeit not significantly.

Conclusion

The use of a no-induction protocol in SKPT is safe and effective immunosuppression that also reduces transplantation costs.

Section snippets

Study Design

Between January 2001 and April 2004, 63 SKPT cases met criteria for inclusion in the study. Patients were divided into two groups: no induction group of 42 patients and anti-IL-2R induction group of 21 SKPT using anti IL-2 receptor monoclonal antibody (two doses of 2 mg/kg daclizumab [Zenapax, Roche], or two doses of 20 mg basiliximab [Simulect, Novartis]). We excluded retransplants; recipients who received induction therapy with monoclonal or polyclonal antilymphocyte preparations; and

Demographics

Table 1 shows the clinical characteristics of the SKPT recipients. Patient age at transplantation, duration of diabetes prior to transplantation, percentage of patients on dialysis, and duration of dialysis prior to transplantation were similar between the groups. Enteric exocrine drainage was performed in 38 patients in the no induction group (90.4%) and 15 patients (71.4%) in the anti-IL-2R induction group (P = NS). The incidence of delayed graft function was also similar in both groups.

Acute Rejection Episodes

In

Discussion

The present study analyzed the safety and efficacy of a no induction protocol compared with anti-IL-2R induction among type 1 diabetic patients undergoing SKPT and receiving the same maintenance immunosuppressive regimen. Our first objective was to analyze whether there was a difference in the incidence of acute rejection episodes in both protocols. The results observed in this study showed equal 1-year acute rejection incidences in both no induction and anti-IL-2R induction cohorts. These

Acknowledgments

We thank Natascha Kim Camaroske for her assistance in database management.

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