Maintenance Immunosuppression Effect on Pancreas Transplant Outcome

For 2000-2004 US DD primary pancreas transplants, there were five main protocols of initial maintenance immunosuppression comprised of Azathioprin (AZA), Cyclosporine (CsA), Mycophenalate Mofetil (MMF), Sirolimus (SIR) and Tacrolimus (Tac) (Figure 21). In the 2000-2004 period, Tac+MMF has been the primary combination. With anti-T-cell induction therapy, GSRs ranged from 83% to 88%, being highest in SPK; these differences are significant.  Since 2000, Sirolimus (SIR) combined with TAC or TAC and MMF was used in 16% of recipients across categories. With anti-T-cell induction therapy, GSRs were 83% PAK and PTA and 87% SPK. These differences are not significant, but the numbers are small with short follow-up time. The SIR differences between TAC+MMF and TAC were not significant (p=>0.31). Prior to 2000, CsA with MMF was the next most frequent combination.

Figure 21

By multivariate models, the reduction in pancreas graft failure rates overall according to HRs with TAC and MMF given was highly significant: 0.74 SPK (p=0.008), 0.51 PAK (p=0.0001) and 0.463 for PTA (p=0.014).  Independently, the use of SIR also decreased the HRs for pancreas graft loss: 0.81 (p=0.17) in SPK, 0.54 in PAK (p=0.01) and 0.54 in PTA (p=0.001). TAC and MMF as maintenance immunosuppression also showed reduces risk for technical failure (TF) (Table 7).

Table 7.    Cox – regression for pancreas graft failure US DD primary pancreas transplants 1/1/2000 – 6/2004

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