Maintenance immunosuppressive (IS) regimens after pancreas transplantation (Tx) continue to evolve. The high immunogenic potential of the pancreas usually requires high-dose administration of calcineurin inhibitors (CNI’s). In order to counter-act the significant nephrotoxic side effects of CNI’s, the m-TOR inhibitor Sirolimus (SRL) is increasingly used as a part of maintenance regimens. Few data exists on the long-term effect of SRL- based maintenance IS on pancreas graft survival.

Objective: Our objective was to investigate the 3-year pancreas graft survival rates based on the use of different maintenance regimens including SRL.

Methods: Data from the IPTR and UNOS for pancreas transplants performed between 2004 to 2011 were analyzed. This analysis included all primary deceased donor pancreas transplants. Re-transplants were excluded. A total of 5,415 pancreas transplants were analyzed (4,077 Simultaneous Kidney/Pancreas (SPK), 845 Pancreas after Kidney (PAK) and 493 Pancreas Transplants Alone (PTA)). Three maintenance IS regimens were compared: (1)Tacrolimus(Tac)/Mycophenolate Mofetil (MMF)/Sirolimus (SRL), (2)Tac/MMF and (3)SRL/MMF. The Kaplan-Meier method was used for statistical analysis; long-rank test were used for comparisons.

Results: In the SRL-free group, the best results were achieved in the SPK category (85%) compared to 72% for PAK and 71% for PTA (p<0.0001). By adding SRL, the results improved markedly (91%, 89% and 83%, p= 0.31). In the CNI-free maintenance group, the results were significantly better in the SPK and PAK categories (92%, 92% vs. 71%, p< 0.003. The data are summarized in Table 1.

Conclusion: Adding SRL to maintenance regimen improves pancreas graft survival in pancreas transplant patients. The combination of Tac/MMF and SRL should be strongly considered in the solitary pancreas transplant categories (PAK, PTA).

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