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Pancreas and kidney transplantation
Jennifer Larsen1, James Lane, Lynn Mack-Shipman
1Department of Internal Medicine, 983020 Nebraska Medical Center, Omaha, NE 69198-3020, USA. jlarsen@unmc.edu
Current Diabetes Reports
|March 20, 2003
Summary
Pancreas transplantation, including simultaneous pancreas-kidney (SPK) or pancreas after kidney (PAK) procedures, offers significant benefits for type 1 diabetes patients with end-stage renal disease. These transplants improve glucose control and reduce diabetic complications, with excellent graft survival rates.
Area of Science:
- Nephrology
- Endocrinology
- Transplantation Immunology
Background:
- End-stage renal disease (ESRD) in diabetic patients often necessitates kidney transplantation or dialysis.
- Type 1 diabetes patients with ESRD may benefit from pancreas transplantation alongside kidney transplantation to improve glycemic control and mitigate diabetic complications.
- Pancreas transplantation alone (PTA) is an option for type 1 diabetes patients with severe hypoglycemia and adequate renal function.
Purpose of the Study:
- To evaluate the efficacy and outcomes of different pancreas transplantation strategies (SPK, PAK, PTA) in diabetic patients.
- To compare graft and patient survival rates across various pancreas transplantation approaches.
- To highlight the benefits of pancreas transplantation in normalizing glucose levels and improving diabetic end-organ complications.
Main Methods:
- Retrospective analysis of patient data comparing outcomes of simultaneous pancreas-kidney (SPK), pancreas after kidney (PAK), and pancreas transplantation alone (PTA).
- Assessment of one-year graft survival rates for pancreas and kidney grafts.
- Evaluation of patient survival rates post-transplantation.
Main Results:
- One-year pancreas graft survival rates were 82% for SPK, 74% for PAK, and 76% for PTA.
- One-year kidney graft and patient survival rates after SPK were comparable to kidney transplantation alone.
- Pancreas transplantation effectively normalized glucose levels, surpassing insulin therapy, and showed potential to improve or halt diabetic end-organ complications.
Conclusions:
- Simultaneous pancreas-kidney (SPK) transplantation offers excellent outcomes for eligible type 1 diabetes patients with ESRD.
- Pancreas transplantation provides superior glycemic control and positively impacts diabetic complications compared to insulin therapy alone.
- Ongoing management by diabetologists and endocrinologists is crucial for addressing residual risks and complications in transplant recipients.