Excellent Short-term Results With Steroid-Free Maintenance Immunosuppression in Low-Risk Simultaneous Pancreas-Kidney Transplantation

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Abstract
SIMULTANEOUS pancreas-kidney transplantation is a well-accepted procedure for patients with type I diabetes mellitus and renal failure. Historically, rejection rates of the pancreas in this type of dual transplantation have been as high as 80%, typically requiring antibody therapy, with an accompanying high rate of graft dysfunction or graft loss due to a failed response.1 With the introduction of both tacrolimus and mycophenolate mofetil (MMF) in the later part of the last decade, rejection rates of the pancreas have dropped considerably.2 This has led several groups to alter both induction immunosuppression as well as maintenance immunosuppression.3-5 With the introduction of sirolimus in the last 2 years, the potential for a protocol that avoids steroid use has been suggested. It is well known that steroids have diabetogenic potential. Additionally, protocols that avoid steroid use in islet cell transplantation have enjoyed good early results, with no obvious problems with rejection.6 Given these concepts, our center embarked on a steroid-free immunosuppression protocol for maintenance immunosuppression. The first 40 patients treated with this regimen are the subjects of this report.