[Diabetes and pancreas transplantation]

Kidney disease is a severe and frequent complication in diabetes. In the terminal phase, treatment requires dialysis and, if possible, kidney transplantation. Provided that there are no contraindications, simultaneous kidney/pancreas transplantation is currently considered the treatment of choice in patients with type 1 diabetes mellitus and terminal kidney disease. Pancreas transplantation is a complex process initially associated with a greater morbidity than kidney transplant alone. At present, however, patient and graft survival is good thereby leading to total normalization of metabolic control and allowing the patient to carry out a normal life without the need to administer insulin and with the consequent benefits in quality of life and the evolution of the complications of the disease. The results of pancreas transplant alone are somewhat worse than those with combined kidney/pancreas transplantation. They are, however, sufficiently satisfactory to be considered a good therapeutic option in patients who have previously received a kidney. Nonetheless, the transplantation of the pancreas alone in diabetic patients without renal insufficiency or previous kidney transplant is another question. Although this type of transplantation would be ideal, it currently remains restricted to patients with a labile diabetes who require repeated hospital admission due to metabolic decompensation and/or severe hypoglycemic episodes accompanied by loss of consciousness.