Experience with ATG short course high dose induction therapy in a series of 112 enteric drained pancreatic transplants.

BACKGROUND: New immunosuppressive protocols and advanced surgical technique resulted in a major improvement in the outcome of pancreatic transplantation.

PATIENTS AND METHODS: 112 enteric drained whole pancreas transplants (PTx) performed at the Innsbruck University Hospital between 3.1997 and 10.2001 were retrospectively analysed. Prophylactic immunosuppression consisted of FK506, MMF and steroids. A short course of high dose ATG induction was given additionally. Perioperative antimicrobial prophylaxis consisted of Amoxicillin/Clavulanic (32 PTx), Pipercillin/Tazobactam (68 PTx), quinolones (10 PTx) or macrolide (2 PTx). 64 patients additionally received fluconazole.

RESULTS: Actuarial patient, pancreas and kidney graft survival at one year were 96.4%, 86.7% and 95.3%, surgical complication rate was 28%, rejection rate 40%. Eight grafts were lost due to intraabdominal infection, seven due to rejection. Median perioperative observation days (OD) were 29 (range 14-125), patients were on antibiotics for 68% of OD, and developed fever on 33% of OD. Incidence of CMV infection was 42% (but only five patients developed CMV disease), HSV 24%, intraabdominal infection 22%, UTI 11%, wound infection 9% and pneumonia: 5%.

CONCLUSION: ATG short course induction is well tolerated after enteric drained PTx. Infection represents a frequent and at least for IA sepsis serious complication after PTx with enteric drainage.