Simultaneous pancreas–kidney transplantation in type 1 diabetes

Abstract

The outcome of simultaneous pancreas-kidney (SPK) transplantation in type 1 diabetes has dramatically improved in recent years because of optimized surgical techniques and new immunosuppressive drug regimens. Normoglycemia is followed by stabilization or even regression of diabetic lesions, i.e., of heart and kidneys. However, these effects are only visible after more than five yr of normoglycemia (achieved by a functioning allograft). This is also a likely explanation for the conflicting results of studies that investigated patient or kidney graft survival in SPK transplantation compared to kidney transplantation alone. Most studies had too short follow-up periods, i.e., less than five yr, to compare effectively different transplant strategies in patients with type 1 diabetes and therefore failed to discover a survival benefit in favor of simultaneously transplanted patients. Recent data now indicate that, with a longer follow-up, there is an increasing survival benefit for simultaneously transplanted patients compared to patients who received a single kidney transplant. This is paralleled by the comparison of simultaneously transplanted patients to patients who received a single kidney transplant from a living donor. A survival benefit for the combined procedure was here visible after 10 yr of follow-up. We give a short overview on SPK transplantation, with a focus on the effects of this procedure on diabetic complications as well as patient and kidney graft survival.

Infertility and ART after transplantation

“…The use of pancreasekidney transplantation (PKT) has been ground breaking in the treatment of patients with severe type 1 diabetes mellitus [31,32]. The first pregnancy was reported in 1986 [33].…”

Predictors of 10-Year Pancreas Allograft Survival After Simultaneous Pancreas and Kidney Transplantation

“…7,8 Based on these data, SPK transplantation is considered to be the treatment of choice for patients with type 1 IDDM and chronic kidney disease (stage 4 or 5). 8 The outcomes after SPK transplantation have significantly improved in recent years because of optimized surgical techniques and new immunosuppressive drug regimens. 9 In addition, the introduction of extensive preoperative cardiac assessment has improved outcomes for recipients with underlying cardiovascular comorbidities.…”

Successful pregnancy after simultaneous pancreas‐kidney transplantation from a brain‐dead donor: The first case report in Japan

“…SPK transplantation is considered to be the treatment of choice for patients with type 1 diabetes mellitus and end‐stage renal disease. The outcome of SPK transplantation has dramatically improved in recent years because of optimized surgical techniques and new immunosuppressive drug regimens 2 . The advantage of SPK transplantation is not only to eliminate dialysis and insulin treatment for patients, but also prevention or stabilization of microvascular and neuropathic complications of diabetes mellitus.…”

“…The advantage of SPK transplantation is not only to eliminate dialysis and insulin treatment for patients, but also prevention or stabilization of microvascular and neuropathic complications of diabetes mellitus. In short, SPK transplantation is an ideal procedure to cure diabetes and its complications in one step 2 . Especially in women with end‐stage renal disease, amenorrhea and infertility are common.…”

“…Simultaneous pancreas‐kidney (SPK) transplantation is revolutionary medical treatment for patients with severe type 1 diabetes mellitus 2 . Internationally, the first SPK transplantation was performed in 1966 with more than 23 000 pancreas transplantations being reported 3,4 .…”