To investigate the feasible immunosuppressive regimen after simultaneous pancreas and kidney transplantation(SPK).

From January 2005 to June 2009, 9 patients with diabetic nephropathy and end stage uremia received SPK. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regime including IL-2 receptor monoclonal antibody induction, tacrolimus, mycophenolate mofetil (MMF) and steroid were used, then converted to tacrolimus monotherapy. The clinical data of the 9 patients were analyzed retrospectively.

SPK was successfully applied to all patients without serious surgical complications such as pancreatitis, graft and pancreatic fistula. One patient died of cardiovascular accident in the early stage after SPK. The other 8 patients were followed up for 4-50 months. Serum creatinine decreased to normal range within 1 week after the operation. The 8 patients achieved euglycemia with insulin independence about 10 days after the operation. Acute rejection of the renal graft occurred in 4 patients, 1 patient died due to cardiovascular accident and the other 3 recovered after ATG or steroids bolus treatment. No rejection was noted in pancreatic grafts.

SPK is an effective treatment for patients with DM related uremia. Quadruple immunosuppressive regime including IL-2 receptor monoclonal antibody induction is feasible after SPK, and such regimen can be safely converted to tacrolimus monotherapy.