Transplantation in patients with diabetic nephropathy: Outcome of combined pancreas and kidney transplantation compared with kidney transplantation only

Abstract

Detailed results of 12 combined pancreas and kidney transplantations (Comb) were compared with those of two matched diabetic controls per patientone living donor kidney recipient (LD) and one cadaveric donor kidney recipient (CD)who, though eligible for pancreas transplantation also, preferred kidney transplantation only. Mean follow-up was 22,23, and 21 months in the three groups. There was no mortality in the LD group, but two CD and one Comb patient died from cardiovascular disease. Two kidneys were lost in both the Comb and the LD group, compared to five in the CD group. Ten major vascular events occurred and three of them were lethal. The only LD case was one below-knee amputation; the other nine were equally distributed in the Comb and CD groups. The time spent in the hospital was shorter for the LD group. Thus, in the short run, LDs confer the best results, whereas in the long term the bettermetabolic control in the Combs may prove favorable.

Surgical Treatment of Diabetes Mellitus with Pancreas Transplantation

“…Recent position statements both from the American Diabetes Association and the American Society of Transplant Surgeons have recommended that pancreas transplantation be considered as an acceptable therapeutic alternative to continued insulin therapy in patients with IDDM and end-stage renal disease who either have already had or plan to have kidney transplants.24 '25 The dual organ transplant procedure eliminates the need both for dialysis and exogenous insulin administration, achieves superior metabolic control, and improves quality of life.26 In spite of increased morbidity, the addition of a pancreas transplant to a kidney transplant in an appropriately selected IDDM patient does not appear to jeopardize either the patient or the kidney transplant and can result in excellent patient and graft survival with greater potential for complete rehabilitation.27-30 A number of groups, including our own, have reported an actual improvement in kidney graft survival after combined PKT versus cadaveric donor kidney transplantation alone in the IDDM patient. [29][30][31][32] Insulin-dependent patients with diabetes mellitus have diminished survival (both short-and long-term) with dialysis versus their nondiabetic counterparts. '5 For this reason, it has become a relatively common practice to consider preemptive kidney transplantation in diabetic patients.…”