Tacrolimus therapy (FK 506) following simultaneous kidney-pancreas transplantation

Tacrolimus has been effectively used as primary therapy in kidney and liver transplantation as well as in rescue therapy for steroid- and/or OKT III resistant rejection episodes. Due to the presumed effects of tacrolimus on glucose metabolism there has been concern about its use in simultaneous pancreas kidney transplantation. We investigated the effects of tacrolimus in simultaneous pancreas kidney transplantation in cases where further therapy with cyclosporine was ineffective or contraindicated. In six out of seven patients treated with tacrolimus, creatinine levels decreased following conversion to tacrolimus. Serum creatinine determined as 3,8 +/- 1,2 mg/dl before conversion decreased to 2,7 +/- 1,5 mg/dl (n = 7) three months thereafter and to 1,4 +/- 0,1 mg/dl (n = 3) at one year. One patient lost his pancreatic graft 4 months after conversion due to a mycotic aneurysm. Before conversion, fasting blood glucose was 147 +/- 33 mg/dl with three patients receiving insulin. Fasting blood glucose decreased to 100 +/- 19 mg/dl three months thereafter with no patient receiving insulin and to 92 +/- 9 mg/dl at one year. In combined pancreas and kidney transplantation. A diabetogenic effect of tacrolimus was not clinically apparent.