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Pilot study of the combi- nation of interferon alpha and ribavirin as therapy of recurrent hepatitis C after liver transplantation. Hepatology 1997; 26: 500. 50. Reichard O, Schvarcz R, Weiland O. Therapy of hepatitis C: alpha interferon and ribavirin. Hepatology 1997; 26: 108S. Received 1 October 1997. Accepted 30 April 1998. 0041-1337/98/6603-318$03.00/0 TRANSPLANTATION Vol. 66, 318 –323, No. 3, August 15, 1998 Copyright © 1998 by Williams & Wilkins Printed in U.S.A. MYCOPHENOLATE MOFETIL IN PANCREAS TRANSPLANTATION RAINER W.G. GRUESSNER, 1 DAVID E.R. SUTHERLAND,MARY BETH DRANGSTVEIT,LUCILE WRENSHALL, ABHINAV HUMAR, AND ANGELIKA C. GRUESSNER Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455 Background. Mycophenolate mofetil (MMF) has been shown to decrease the incidence of acute rejec- tion episodes after kidney transplantation. The use of MMF along with tacrolimus for >1 year after pancreas transplantation has not been studied in a large single- center analysis. Methods. Between July 1, 1995 and June 30, 1997, both MMF and tacrolimus were given to 120 pancreas transplant recipients. By category, 61 underwent si- multaneous pancreas-kidney transplantation (SPK); 44 underwent pancreas transplantation after previous kidney transplantation (PAK); and 15 underwent pan- creas transplantation alone (PTA). By donor source, 86% of the grafts were from a cadaver, and 14% were from a living-related donor. Induction therapy was with MMF, tacrolimus, prednisone, and antithymocyte globulin (n109) or OKT3 (n2). Until oral intake was resumed, recipients initially received intravenous azathioprine. Side effects were as follows: gastrointes- tinal (GI) toxicity in 53% of recipients receiving com- bined MMF and tacrolimus therapy; bone marrow tox- icity in 24% of recipients receiving MMF alone; nephrotoxicity in 18% and neurotoxicity in 11% of re- cipients receiving tacrolimus alone. We did a matched- pair analysis to compare outcome in MMF versus aza- thioprine recipients, using the database of the International Pancreas Transplant Registry. Match- ing criteria included transplantation category, trans- plantation number, recipient and donor age, duct management, HLA typing, and transplantation year. Results. One-year patient survival rates were 98% for SPK, 98% for PAK, and 100% for PTA (PNS). For SPK recipients, 1-year pancreas graft survival rates were 86% with MMF versus 79% with azathioprine (PNS); kidney graft survival rates were 96% with MMF versus 86% with azathioprine (PNS). The inci- dence of first rejection episodes at 1 year was signifi- cantly lower for MMF recipients (15% with MMF ver- sus 43% with azathioprine) (P0.0003). For recipients of solitary pancreas transplants (PTA and PAK), we found no difference in graft survival rates between MMF and azathioprine. The conversion rate from MMF to azathioprine at 1 year was 14% for SPK recip- ients, 26% for PAK, and 39% for PTA (P<0.007). The most common reason for conversion was GI toxicity, in particular for nonuremic (PTA) or posturemic (PAK) recipients. The rates of posttransplant infection and lymphoproliferative disease were low for recipients on MMF and tacrolimus. Conclusions. The combination of MMF and tacroli- mus after pancreas transplantation is highly effective 1 Address correspondence to: Dr. Rainer W.G. Gruessner, Depart- ment of Surgery, University of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. TRANSPLANTATION 318 Vol. 66, No. 3