Modern indications for referral for kidney and pancreas transplantation

Abstract

Purpose of review Pancreas transplantation (PTx) is currently the only therapy that can predictably achieve sustained euglycemia independent of exogenous insulin administration in patients with insulin-dependent diabetes mellitus. This procedure involves a complex abdominal operation and lifetime dependence on immunosuppressive medications. Therefore, PTx is most frequently performed in combination with other organs, usually a kidney transplant for end stage diabetic nephropathy. Less frequently, solitary PTx may be indicated in patients with potentially life-threatening complications of diabetes mellitus. There remains confusion and misperceptions regarding indications and timing of patient referral for PTx. Recent findings In this review, the referral, evaluation, and listing process for PTx is described, including a detailed discussion of candidate assessment, indications, contraindications, and outcomes. Summary Because the progression of diabetic kidney disease may be less predictable than other forms of kidney failure, early referral for planning of renal and/or pancreas transplantation is paramount to optimize patient care and allow for possible preemptive transplantation.

Does dialysis modality or duration influence outcomes in simultaneous pancreas‐kidney transplant recipients? Single center experience and review of the literature

“…The most frequent form of beta‐cell replacement therapy is simultaneous pancreas‐kidney transplantation (SPKT), which is the preferred therapy in appropriately selected patients with end stage renal disease (ESRD) and insulin‐dependent diabetes mellitus 1–6 . By inducing remission of diabetes mellitus and alleviating ESRD, improvements in life expectancy and quality of life can be realized with SPKT compared to alternative therapies 1,2,4 . However, these benefits of SPKT are juxtaposed with the finite surgical risks associated with a major vascular and intra‐abdominal procedure and the need for chronic daily immunosuppression 1–4 .…”

“…The most frequent form of beta-cell replacement therapy is simultaneous pancreas-kidney transplantation (SPKT), which is the preferred therapy in appropriately selected patients with end stage renal disease (ESRD) and insulin-dependent diabetes mellitus. [1][2][3][4][5][6] By inducing remission of diabetes mellitus and alleviating ESRD, improvements in life expectancy and quality of life can be realized with SPKT compared to alternative therapies. 1,2,4 However, these benefits of SPKT are juxtaposed with the finite surgical risks associated with a major vascular and intra-abdominal procedure and the need for chronic daily immunosuppression.…”

“…[1][2][3][4][5][6] By inducing remission of diabetes mellitus and alleviating ESRD, improvements in life expectancy and quality of life can be realized with SPKT compared to alternative therapies. 1,2,4 However, these benefits of SPKT are juxtaposed with the finite surgical risks associated with a major vascular and intra-abdominal procedure and the need for chronic daily immunosuppression. [1][2][3][4] In the past 30 years, steadily improving outcomes in SPKT have emerged due to better donor and recipient selection and management, progress in organ preservation and immunosuppression, innovations in surgical techniques, and advances in general medical care and our understanding of diabetes pathophysiology.…”

“…1,2,4 However, these benefits of SPKT are juxtaposed with the finite surgical risks associated with a major vascular and intra-abdominal procedure and the need for chronic daily immunosuppression. [1][2][3][4] In the past 30 years, steadily improving outcomes in SPKT have emerged due to better donor and recipient selection and management, progress in organ preservation and immunosuppression, innovations in surgical techniques, and advances in general medical care and our understanding of diabetes pathophysiology. [1][2][3][4][5][6] In kidney transplantation alone (KTA), longer dialysis duration pretransplant (usually defined as at least 2-5 years) has been associated with an increased risk of death and graft loss.…”

“…[1][2][3][4] In the past 30 years, steadily improving outcomes in SPKT have emerged due to better donor and recipient selection and management, progress in organ preservation and immunosuppression, innovations in surgical techniques, and advances in general medical care and our understanding of diabetes pathophysiology. [1][2][3][4][5][6] In kidney transplantation alone (KTA), longer dialysis duration pretransplant (usually defined as at least 2-5 years) has been associated with an increased risk of death and graft loss. [7][8][9][10][11] It is also well established that extended dialysis duration is correlated with higher kidney wait-list mortality, particularly in those patients with diabetes.…”