D. J. Taraskiewicz1, D. J. Taber1, S. Nadig1, J. McGillicuddy1, K. D. Chavin1, P. K. Baliga1, C. F. Bratton1 1Medical University Of South Carolina,Charleston, Sc, USA
Introduction: Pancreas transplantation (PTX) is the only treatment which reestablishes the euglycemic state in patients with diabetes. Success of PTX is predicated upon minimizing deleterious infection and rejection episodes. Induction immunosuppression (II) including IL2 receptor antagonists (IL2) and depleting antibodies (DA) are utilized to attenuate rejection in PTX in 90% of cases nationally; however, data regarding optimal II modality in PTX is inadequate. The aim of this analysis was to examine the risks and benefits of II compared across PTX type: simultaneous PTX (SPK) vs. Pancreas after kidney (PAK) or pancreas transplant alone (PTA).
Methods: This was a respective analysis of PTX performed at MUSC between 2000-2014 using medical records to determine one year rates of infection, rejection, graft loss, and patient death for IL2 vs DA II, with sub-analyzes by ethnicity. Data included baseline donor and patient characteristics, univariate factors were evaluated with SPSS v22. Factors demonstrating significant differences were included in multivariate modeling. Patients with graft loss or mortality within the first month due to surgical complications were excluded.
Results: 205 PTX were included (154 [75%] SPK, 51 [25%] PAK/PTA); 1 yr infection rates were significantly higher for SPKs induced with DA vs. IL2 (41% vs 25%; p=0.033), while1 yr infection rates for PAK/PTA trended towards significance (41% DA vs. 21% IL2; p=0.202). There was no difference in rejection rates in SPKs (10% DA vs. 16% IL2; p=0.355). However, in the PAK/ PTA group, DA use demonstrated a trends towards improvement in 1 yr rejection (27% DA vs. 43% IL2; p=0.277), and graft loss (5.4% DA vs. 21.4% IL2; p=0.086). II in African Americans (AA) receiving PTX did not influence infections (46% vs. 36%; p=0.357) or rejections (15% DA vs. 13% IL2; p=0.745).
Conclusion: These results suggest that the efficacious use of II in PTX is dependent on transplant type, with SPKs benefiting more from IL2, as evident by lower infection rates without differences in the rejection risk. In contrast, PAK/PTAs appear to benefit from DA. Although ethnicity may influence outcomes in PTX, II efficacy was not dramatically different based on recipient ethnicity.
