Successful Simultaneous Islet-Kidney Transplantation using a Steroid-free Immunosuppression: Two-Year Follow-up

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We report on the feasibility of a glucocorticoid-free immunosuppression (sirolimus, low-dose tacrolimus, and daclizumab) in simultaneous islet-kidney transplantation in nine patients with type 1 diabetes. There was one renal primary nonfunction. Renal function (n = 8) as assessed by creatinine and creatinine clearance over time was 103 ± 6 μmol/L and 64 ± 6 mL/min/1.73 m2, respectively. Five out of six patients with ≥ 2 islet transplantations became insulin independent. The mean HbA1c during the follow-up period for all patients after transplantation is 6.2 ± 0.9% as compared with 8.7 ± 1.9% prior to transplant. These results in patients with a median follow-up of 2.3 years suggest that kidney transplantation under a glucocorticoid-free immunosuppression is feasible, and that the rate of insulin independence of 80% can be achieved not only in patients with no or minimal diabetes complications, but also in patients with more advanced late complications and in conjunction with kidney transplantation.

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