Between January 1990 and December 2014, 800 combined kidney pancreas transplant procedures were performed at The Ohio State University. The immunosuppressive protocols have changed significantly over time reflecting the introduction of new more effective drugs. While Cyclosporine remained the integral part of all immunosuppressive protocols used in all eras, the remaining agents were changed. This twenty five year period can be divided into three eras as defined by the immunosuppressive protocol employed. In era one (Group I, 1990 until June 1995, N=245), cyclosporine along with azathioprine and prednisone provided the maintenance immunosuppression. In era two (Group II, July 1995 to August 2003, N=274) Mycophenolate Mofetil replaced azathioprine, combined with cyclosporine micro emulsion and prednisone. In era three, (Group III, August 2003 to December 2014, N=281), rapamycin and cyclosporine micro emulsion without prednisone were used. This study compares the short and long term clinical outcomes for these three eras. The 1 year biopsy proven acute rejection rates decreased significantly from Group I through Group III (Group I: 21.9%, Group II: 10.9%, and Group III 5.4%, p<0.001). Actual graft (pancreas=panc, kidney=kid) survivals and patient (pt) survivals at one and two years (table 1) and three and five years (table 2) are shown . While 1, 2, and 3, graft survival improved, 5 year graft survival as well as patient survivals did not change appreciably. We conclude that an incremental improvement in the outcomes regarding 1^st year acute rejection rate and years 1 through 3 actual graft survivals was achieved as our immunosuppressive regimens have evolved. The current steroid free, cyclosporine and rapamycin immunosuppressive regimen has resulted in our best short and long term outcomes.

CITATION INFORMATION: Rajab A, Pelletier R, El-Hinnawi A, Elkhammas E, Bumgardner G, Henry M. The Impact of Different Immunosuppressive Protocols on Early and Long Term Outcomes After Kidney and Pancreas Transplantation. Am J Transplant. 2016;16 (suppl 3).

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