Low rejection rate with high-dose ATG bolus therapy in simultaneous pancreas and kidney transplantation.

IN PANCREAS and kidney transplantation, intensive induction therapy is mandatory because of the difficulty in performing rejection diagnosis; the frequent low histocompatibility between the donor and recipient; and, when combined with kidney transplantation, large transplanted tissue mass. According to the International Pancreas Transplant Registry, polyclonal or monoclonal antibody induction therapy has therefore been used in 75% of simultaneous transplants performed in the USA from 1994 to 1998. Antibody therapy, however, can cause considerable side effects, is expensive, and may prolong hospitalization. The introduction of new and more potent immunosuppressive drugs such as tacrolimus and mycophenolate mofetil (MMF) has brought about the question of whether antibody therapy is still necessary. Certain compromise could represent acceptable short-term, yet intensive anti–T-lymphocyte therapy initiated just before graft exposure to the allogeneic milieu. In kidney transplantation, triple-drug therapy, together with intraoperative T-cell depletion, has proven to be superior to triple-drug therapy without T-cell depletion in terms of long-term patient and graft survival and, in combination with tacrolimus and MMF, was shown to be equivalent to 10-day ATG therapy with azathioprine and cyclosporine in combined pancreas and kidney transplantation. The aim of the present study was to evaluate the incidence of rejection and adverse events as well as the possibility of early withdrawal of steroids in a series of consecutive pancreas and kidney transplantations (n 5 24).