Introduction: Utilization of rabbit antithymocyte globulin (RATG) induction as part of a steroid free immunosuppression protocol in orthotopic liver transplantation has gained wide acceptance in recent years. Our center has recently reported favorable longterm outcomes in a large cohort of liver transplant patients using this protocol. Utilization of steroid free immunosuppression in simultaneous liver-kidney transplantation (SLKT) has not been reported. The purpose of this report is to evaluate steroid-free immunosuppression in this patient population.

Methods: We evaluated outcomes of 47 patients who underwent SLKT between June 2006 and October 2013. Patients with less than 1 year of available follow-up or those undergoing re-transplant were excluded. Induction therapy with RATG was used, and immunosuppression maintained using post-operative mycophenolate mofetil with delayed initiation of tacrolimus.

Results: Twenty-five patients required hemodialysis prior to transplant. Mean posttransplant creatinine was 1.84 (range 0.4-8.8) at 1 month, and improved to 1.26 (range 0.1-5.1) at 1 year. Tacrolimus was initiated at post-operative day 5.5 on average, with a mean level of 6.1 at one year. Biopsy proven rejection occurred in 9 patients (19.1%), and 5 of these patients (10.6%) required steroids. Postoperatively, four patients developed either diabetes mellitus or hypertension (4.2% each). One-year patient and graft survival was 87.2% and 85.1%, respectively. Three-year survival was 82.7%, and five year survival was 70.3%.

Conclusion: This is the first reported series of steroid free immunosuppression in SLKT using RATG induction. As has been demonstrated in liver transplantation, this protocol offers excellent outcomes, low risk of rejection, and minimizes development of postoperative diabetes mellitus and hypertension in SLKT patients.

« Back to 2015 American Transplant Congress