Benefits and complications associated with kidney-pancreas transplantation in diabetes mellitus
- Christina L Klein, MD
Christina L Klein, MD
- Transplant Nephrologist
- Piedmont Transplant Institute
- Tarek Alhamad, MD, MS, FACP, FASN
Tarek Alhamad, MD, MS, FACP, FASN
- Assistant Professor of Medicine
- Washington University School of Medicine
- Section Editors
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
Combined kidney-pancreas transplantation is an established treatment for selected diabetic patients with end-stage diabetic nephropathy. More than two-thirds of pancreas transplants are performed as simultaneous pancreas-kidney (SPK) transplants, with the remainder performed as sequential pancreas after kidney (PAK) transplant or pancreas transplant alone (PTA) .
While SPK transplantation usually employs grafts procured from a single deceased donor, PAK typically involves transplantation of a deceased-donor pancreas graft into a recipient with a functioning living- or deceased-donor kidney allograft. Selected patients without substantial renal disease may be candidates for PTA.
The benefits and nonimmunologic complications associated with combined or sequential kidney-pancreas transplantation in patients with diabetes mellitus are presented here. Patient selection for and the clinical approach to these procedures are discussed separately. (See "Patient selection for and immunologic issues relating to kidney-pancreas transplantation in diabetes mellitus".)
Overview — The major benefits of combined kidney-pancreas transplantation are decreased mortality and improved quality of life. The decreased mortality is due in part to the well-established survival benefit conferred by kidney transplantation (ie, even without pancreas transplantation) compared with dialysis . (See "Patient survival after renal transplantation", section on 'Survival compared with dialysis'.)
The improved quality of life is due to freedom from frequent blood sugar monitoring, insulin therapy, hypoglycemia, and dialysis [3-6].
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