Patient selection for and immunologic issues relating to 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
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
- 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, definitive 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) .
This topic reviews patient selection for and the approach to combined or sequential kidney-pancreas transplantation in patients with diabetes mellitus and end-stage renal disease (ESRD). Patient and graft outcomes, other benefits and complications (other than those induced by immunosuppression) associated with these procedures, and the diagnosis and treatment of rejection are discussed elsewhere. (See "Benefits and complications associated with kidney-pancreas transplantation in diabetes mellitus".)
The roles of PTA and islet transplantation in diabetic patients without renal failure are discussed separately. (See "Benefits and complications associated with kidney-pancreas transplantation in diabetes mellitus" and "Pancreas and islet transplantation in diabetes mellitus".)
Nearly 27,000 pancreas transplants were performed worldwide between 1978 and 2007. In the United States during 2013, 760 simultaneous pancreas-kidney (SPK), 127 pancreas transplantation alone (PTA), and 107 pancreas after kidney (PAK) transplants were performed .
While SPK most often employs grafts procured from a single deceased donor after brain death, some are simultaneous living-donor kidney and deceased-donor pancreas, and a few SPK (2.6 percent) are from a deceased donor after cardiac death .
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- SELECTION OF OPTIMAL PROCEDURE
- PATIENT SELECTION
- Cardiovascular evaluation
- Evaluation of peripheral vascular disease
- SURGICAL CONSIDERATIONS
- Segmental pancreas donation
- Induction therapy
- Maintenance regimen
- SUMMARY AND RECOMMENDATIONS