Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Abstract

Type 1 diabetes mellitus (T1DM) is one of the important causes of chronic kidney disease (CKD) and end-stage renal failure (ESRF). Even with the best available treatment options, management of T1DM poses significant challenges for clinicians across the world, especially when associated with CKD and ESRF. Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM. Simultaneous pancreas-kidney transplant (SPK) is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications. However, limited availability of the organs for transplantation, the need for long-term immunosuppression to prevent rejection, peri- and post-operative complications of SPK, lack of resources and the expertise for the procedure in many centers, and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe. This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Surgical complications and technical failure of simultaneous pancreas‐kidney transplantation: A 22‐year experience from a single center

“…Studies consistently demonstrate its superiority in prolonging patient survival, reducing the development and progression of peripheric vascular disease, and reducing mortality rates compared to alternative treatments for end-stage renal disease and insulin-dependent diabetes mellitus. [4][5][6][7] Over the last decades, SPKT outcomes have improved, thanks to technical advances, better donor and recipient selection, new immunosuppressive agents, and increased knowledge regarding the management of complications. [8][9][10][11] Despite the promising results, it should be noted that SPKT is a complex procedure that can lead to surgical complications resulting in graft loss, impaired kidney function, increased recipient mortality, and an extended hospital length of stay (LOS).…”

“…SPKT stands as a transformative intervention, restoring endocrine function, enhancing the quality of life, reducing cardiovascular risk, and ensuring favorable long‐term survival outcomes. Studies consistently demonstrate its superiority in prolonging patient survival, reducing the development and progression of peripheric vascular disease, and reducing mortality rates compared to alternative treatments for end‐stage renal disease and insulin‐dependent diabetes mellitus 4–7 …”