Increased early rejection rate after conversion from XXXX in kidney and pancreas transplantation.

@entity1 @entity137 @entity6 @entity229 @entity660 @entity205 @entity618 @entity1140 @entity1381 @entity4854 @entity454
CONTEXT: A successful immunosuppression regimen for combined kidney and pancreas transplants is @entity1140 , @entity618 , and @entity229 . However, not all @entity1 tolerate these immunosuppressants especially @entity1140 . OBJECTIVE: To evaluate the efficacy of @entity205 as a rescue agent for @entity1140 @entity137 in combined kidney and pancreas transplants. DESIGN: Retrospective. SETTING: Single center. @entity1 : Thirty-five combined kidney and pancreas transplants were performed between July 1994 and January 1999. All @entity1 were insulin dependent @entity6 with @entity454 . Twenty-eight (mean age: 36 years and 57% female) were available with at least 12 month follow-up. INTERVENTIONS: Conversion to @entity205 following renal (biopsy proven) or @entity660 . MAIN OUTCOME MEASURES: @entity137 , rejection rate, and @entity1 /transplant organ survival. RESULTS: Nineteen transplant recipients (68%) were continuously maintained on @entity1140 while nine (32%) required conversion to @entity205 75 +/- 20 days post-transplant. Reasons for conversion included: @entity4854 (n=2), @entity1381 (n=1), and severe @entity1140 nephrotoxicity (n=6). By 12 months post-transplant, the 19 @entity1 maintained on @entity1140 had 5 rejections (26%). Three of the 9 @entity1 (33%) converted to @entity205 had an acute rejection prior to conversion. Seven of these 9 @entity1 (78%; P=0.017 vs. @entity1 maintained on @entity1140 ) had rejections an average of 25 +/- 4 days post-conversion. Four of the 7 @entity1 had no previous rejections prior to conversion. In spite of increased rejections, the 1- and 2-year @entity1 /graft survivals were unchanged by converting. CONCLUSIONS: Converting to @entity205 from @entity1140 was associated with an increased risk of acute rejection especially within the first 30 days post conversion.
