Purpose: We retrospectively analyzed the longterm survival and function in pancreas grafts after reduction of immunosuppression due to polyomavirus infection in simultaneous pancreas kidney transplants (SPK) performed at our center.

Methods: In totally 6 SPK recipients (among them one renal retransplant within a functioning pancreas) a polyomavirus infection was diagnosed by serum PCR in all cases (additionally biopsy proven in three patients) at mean 9.6 (1-30) months post transplant. The preceeding immunosuppression consisted of tacrolimus (TAC, n=5) or cyclosporine A (CyA, n=1) combined to MMF and steroids after an induction therapy with thymoglobuline (n=5) or alemtuzumab (n=1). The therapeutic regimens in the polyomavirus infection consisted of a dose reduction of TAC/CyA in all patients, conversion from TAC to CyA (n=2), permanent discontinuation of MMF (n=1) and application of Leflunomide (n=3). The mean observation time was 35.3 (9-92) months.

Results: 5/6 (=83.3%) pancreas grafts remained at stable function within normoglycaemia without requirement of exogenous insulin and normal values of c-peptide. One pancreas was lost due to chronic rejection at month 21. Two kidneys were lost at month 11 and 13, respectively. The mean serum creatinine in the remaining renal grafts was 1.9 (1.0 – 2.6) mg/dL. The polyomavirus serum PCR turned completely negative in two patients at mean month 4.5 (2-7) after diagnosis and significantly decreased in four patients at mean month 12.0 (8-18).

Conclusion: a stable function in pancreas grafts can be kept if the immunosuppression is cautiously reduced in polyomavirus infected SPK patients. An early and regular post transplant screening of polyomavirus serum PCR is recommended.

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