Pancreatic transplantation: Brief review of the current evidence

Abstract

Kidney transplantation is the treatment of choice for management of end-stage renal disease. However, in diabetic patients, the underlying metabolic disturbance will persist and even may get worse after isolated kidney transplantation. Pancreatic transplantation in humans was first introduced in 1966. The initial outcome was disappointing. However, this was changed after the improvement of surgical techniques together with better patient selection and the availability of potent and better-tolerated immune-suppression like cyclosporine and induction antibodies. Combined kidney and pancreas transplantation will not only solve the problem of organ failure, but it will also stabilise or even reverse the metabolic complications of diabetes. Combined kidney and pancreas transplantation have the best long term outcome in diabetic cases with renal failure. Nevertheless, at the cost of an initial increase in morbidity and risk of mortality. Other transplantation options include pancreas after kidney transplantation and islet cell transplantation. We aim by this work to explore various options which can be offered to a diabetic patient with advanced chronic kidney disease. Our work will provide a simplified, yet up-to-date information regarding the different management options for those diabetic chronic kidney failure patients.

Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population after Undergoing Coronary Artery Bypass Grafting

“…Transplant recipients who underwent CABG were younger, with the youngest ages seen in PTx and KPTx (51 years). KPTx had the greatest percentage of CABGs performed emergently (56.0%) and the highest Elixhauser Comorbidity Index score (11). The percentage of diabetes was greater in all transplant groups compared with Non-Tx, with the highest in KPTx (64.1%).…”

“…The addition of pancreas transplantation limits diabetic complications, improves lipid profile, and enhances quality of life for type 1 diabetics with renal failure. [10][11][12][13][14][15] The normalization of blood glucose levels reduces progression of atherosclerosis, and by extension, lowers the risk of CVD. 12,13 Kidney-pancreas transplant recipients show improved survival compared with those who remain on dialysis.…”

Pancreas before Kidney Transplant in Diabetic Patients with Uremia

“…For patients with labile DM and ESRD, SPK would be a preferred treatment because it can simultaneously provide an insulin-free and dialysis-free life for patients during the same operation [4][5][6][7][8][9] . Nevertheless, SPK has also been claimed to have the best long-term outcome in diabetic cases with renal failure 10,11 . However, pancreas and kidney transplants are not necessarily to be accomplished at the same time because both pancreas and kidney are not vital organs.…”

“…Kidney transplant is the well-known treatment of choice for ESRD patients. However, in diabetic patients, the underlying metabolic disturbance will persist and even may get worse after isolated kidney transplant 10 . Currently, PAK has also been an acceptable option for those previously receiving a kidney graft in many centers 1,12,13 .…”

Insulin secretion and action after pancreas transplantation. A retrospective single-center study

“…Successful pancreas transplantation has several advantages both in a short-and long-term perspective, including restoration of normal blood glucose levels without the need for insulin therapy and a reduced risk of developing long-term diabetic complications like retinopathy, neuropathy and nephropathy [6]. Advances in surgical technique and immunosuppressive therapy have improved outcomes after pancreas transplantation during later years, but these procedures still have more postoperative complications and graft failure than other solid abdominal organ transplantations [7,8]. Previous studies have shown that pancreas graft survival is superior following SPK than after PTA [5,9].…”