Simultaneous pancreas-kidney transplantation: evaluation of graft function, cholesterol, triglycerides, and immunosuppressive regimens.

AIMS: To evaluate pancreas graft function, use of insulin, cholesterol, triglyceride levels, prescription of lipid-lowering drugs, and immunosuppressive regimens among recipients of simultaneous pancreas-kidney transplants (SPKT), who had initial immunosuppression with tacrolimus, sirolimus, and corticosteroids.

METHODS: From 2000 to 2007, we performed 73 SKPT, among which we conducted a retrospective data analysis on 51 medical records of patients who had been followed for at least 6 to 72 months. We excluded from the analysis eight recipients who died before 6 months: eight with early pancreas graft losses and six for continued follow-up in other centers.

RESULTS: There were four pancreas graft losses after 6 months due in two diabetes mellitus recurrence, one posttuberculosis treatment, and one after use of nonsteroidal inflammatory medication. Mean plasma glucose levels ranged from 84 to 103 mg/dL, while glycosylated hemoglobin (HbA1) levels ranged from 5.7% to 6.2%. At 6, 12, 36, and 60 months, 80%, 91%, 86%, and 75% of recipients, respectively, had HbA1 lower than 6.5%. In the same period, 10%, 8%, 10%, and 11% of recipients became insulin-dependent. Mean cholesterol levels (mg/dL) at 6, 12, 36, and 60 month were 190, 180, 196 and 193, while triglyceride levels (mg/dL) were 162, 129, 106, and 113 respectively. Recipient's rate of lipid-lowering drug use was 18%, 21%, 20%, and 22% at 6, 12, 36, and 60 months. Mean serum creatinine levels (mg/dL) with standard deviations were 1.3 +/- 0.4, 1.5 +/- 0.4, 1.6 +/- 0.5, 1.8 +/- 0.9, at 6, 12, 36 and 60 months respectively. Nineteen recipients had sirolimus suspended and 14 recipients, tacrolimus suspended as well for various reasons.

CONCLUSION: Mean plasma glucose levels were normal during the period. About 10% of recipients became insulin-dependent and 20% required lipid-lowering drugs. The immunosuppressive regimen protocol had to be changed in 60% of patients.