Sirolimus vs mycophenolate mofetil (MMF) in primary combined pancreas and kidney transplantation. Results of a long-term prospective randomized study

Peter Girman, Květoslav Lipár, Matěj Kočík, Luděk Voska, Radomíra Kožnarová, Tomáš Marada, Věra Lánská, František Saudek, Peter Girman, Květoslav Lipár, Matěj Kočík, Luděk Voska, Radomíra Kožnarová, Tomáš Marada, Věra Lánská, František Saudek

Abstract

The study was intended to compare pancreas graft survival rates in two groups of pancreas and kidney transplant recipients prospectively randomized to treatment either with sirolimus or MMF. From 2002 to 2013, 238 type 1 diabetic recipients with end-stage kidney disease were randomized 1:1 to sirolimus or MMF treatment. Noncensored pancreas survival at 5 years was 76.4 and 71.6% for sirolimus and MMF groups, respectively (P > .05). Death-censored pancreas survival was better in the sirolimus group (P = .037). After removal of early graft losses pancreas survival did not differ between groups (MMF 83.1% vs sirolimus 91.6%, P = .11). Nonsignificantly more grafts were lost due to rejection in the MMF group (10 vs 5; P = .19). Cumulative patient 5-year survival was 96% in the MMF group and 91% in the sirolimus group (P > .05). Five-year cumulative noncensored kidney graft survival rates did not statistically differ (85.6% in the sirolimus group and 88.8% in MMF group). Recipients treated with MMF had significantly more episodes of gastrointestinal bleeding (7 vs 0, P = .007). More recipients in the sirolimus group required corrective surgery due to incisional hernias (21 vs 12, P = .019). ClinicalTrials No.: NCT03582878.

Keywords: clinical research/practice; diabetes: type 1; immunosuppressant - mechanistic target of rapamycin: sirolimus; pancreas/simultaneous pancreas-kidney transplantation.

© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.

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