*Purpose: The study purpose was to analyze 10-year outcomes of depleting antibody induction agents in simultaneous pancreas-kidney transplant (SPKT) at a single center

*Methods: From 2/02 thru 12/10, 114 primary SPKT patients (pts) received either multi-dose rATG (n=57; minimum of 3 daily doses at 1.5 mg/kg) or single dose Alem induction (n=57; 30 mg intra-operatively); 45 (39.5%) were in a randomized trial comparing the two induction regimens. All pts received FK/MPA ± steroids.

*Results: Mean donor (30 rATG vs 26 years Alem) and recipient ages (43 rATG vs 45 yrs Alem) were comparable as were other characteristics (21% were African American). All pts in the rATG had at least 10 yrs follow-up (mean 144 months) whereas all pts in the Alem group had at least 8 yrs f/u (mean 116 months). 10-year pt survival rates were 77% rATG vs 75% Alem. Mean time to death was 108 months rATG vs 68 months Alem; 9 pts in the rATG group died after 10 years vs none in the Alem group (38 had at least 10 yr f/u). Major causes of death were cardiovascular (5 in each group), malignancy (4 rATG vs 1 Alem), and infection (9 rATG vs 2 Alem, p=0.053). 10-year kidney (60% rATG vs 61% Alem) and pancreas graft survival rates (GSR, 47% rATG vs 51% Alem) were comparable. The proportion of pts who died with both grafts functioning (14% rATG vs 16% Alem) and who experienced death-censored dual graft loss (GL, 7% rATG vs 5% Alem) were comparable. Death-censored kidney (56% rATG vs 72% Alem, p=0.17) and pancreas GSRs (43.5% rATG vs 64% Alem, p=0.059) were slightly higher in the Alem group. The frequency of late kidney (17.5% rATG vs 12% Alem) and pancreas GLs (26% rATG vs 12% Alem, p=0.095) were slightly higher in the rATG group

*Conclusions: Similar long-term results can be achieved with either rATG or Alem induction although Alem may be associated with fewer late deaths from infection and fewer late pancreas GLs from rejection.

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