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Presenter: G., Woeste, Frankfurt, Germany
Authors: G. Woeste, I. Hauser, C. Moench, E. Scheuermann, H. Geiger, W.O. Bechstein
Single shot rATG (Thymoglobulin) successfully prevents rejection and immunologic graft loss in simultaneous pancreas kidney transplantation
G. Woeste1, I. Hauser2, C. Moench1, E. Scheuermann3, H. Geiger2, W.O. Bechstein1
1 Goethe University, Department of General and Visceral Surgery, Frankfurt, Germany; 2 Goethe University, Department of Nephrology, Frankfurt, Germany; 3 KfH Dialysis and Kidney Transplantation, Frankfurt, Germany
Simultaneous pancreas kidney transplantation (SPK) is a life preserving therapy for type 1 diabetics with end-stage renal disease. With immunosuppressive protocols including T-cell-depleting antibodies the incidence of acute rejection (AR) is about 20% and immunologic graft loss is about 2%. The purpose of this prospective study was to evaluate the incidence of AR and graft survival with a novel induction protocol of single shot rATG (Thymoglobulin) in SPK. From 1/04 to 1/11 51 SPK were performed. Three patients had different induction therapy, one due to high risk EBV status, and two because of high levels of HLA-antibody. A total of 48 patients received single shot rATG (2.5 mg/kg) started before skin incision. For maintenance immunosuppression prednisone, TAC and MMF was administered. One patient received sirolimus and TAC within a study. For antiviral prophylaxis valganciclovir was given for 3 months in case of CMV positive donors. All patients underwent SPK with enteric and systemic venous drainage. The mean age was 42.0±7.5 years. Patient, pancreas, and kidney graft survival was 93.8%, 79.2% and 89.6%, respectively, with a mean follow-up of 47 months. AR was suspected and treated in 13/48 (27.1%) patients 33.6 days after transplantation. In 9 (18.8%) cases the kidney biopsy showed histological signs of AR (Banff Ia n=5, Ib n=1, IIa n=1, IIb n=1, IIIv3 n=1), 2 biopsies were negative for AR. 12/13 rejections were treated successfully using steroids (n=10), increase of TAC levels (n=1), and rituximab (n=1). In one case both grafts had to be removed due to acute hemorrhage in vascular rejection. Thus only 1/48 (2.1%) patient lost the organs associated with rejection. The incidence of AR is low using single shot rATG. Nearly all AR episodes can be treated successfully with steroids. Graft loss due to rejection is very rare.
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