Antilymphocyte induction is no longer necessary in simultaneous pancreas and kidney transplantation

Antilymphocyte induction therapy (ALI) has been widely used in simultaneous kidney and pancreas transplantation (SPK) because of the high immunogenicity of this transplant. In the United States, almost three-quarters of 1996 to 2000 SPK recipients received anti-T-cell agents as induction, regardless of the maintenance immunosuppression regimen.1 In the past, ATG and OKT3 were preferred; more recently, anti-IL2 receptor monoclonal antibodies have become more common. The advantages of ALI are a lower rejection rate, the delayed onset of rejection episodes, and a lower severity of rejection. On the other hand, ALI treatment carries the risk of overimmunosuppression and a higher cost of the treatment. The introduction of tacrolimus (TAC) and mycophenolate mofetil (MMF) has significantly reduced the rejection rate, suggesting that SPK could be performed without ALI. The aim of our study was to review our experience of SPK without ALI in a group of patients operated using a single surgical technique and treated a single immunosuppressive protocol.