Pancreas-kidney Tx combination is now stabilized therapy for selected diabetics with ESRD. Pancreas Tx is performed as SPK transplants (most commonly
o If rATG is given, we start intraoperative IV rATG-Thymoglobulin as mg/kg. The intraoperative starting dosing of rATG is followed by 1.5- 2 mg/kg of rATG /d. for the next 2-3 days reaching a total cumulative induction dose of mg/kg. rATG is given if, at presentation, the WBCs is > 2000/microL & the platelet count is > 75,000/ microL. If rATG cannot be given, we give Alm.
o Alm is given as single IV or SQ dose of mg at the timing of Tx.
o Majority of ptns can start GC, oral Prd tapered to 5 mg/d by 1-2 mo after Tx.