Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review

Area of Science:

• Nephrology
• Endocrinology
• Transplantation immunology

Background:

• Optimal glycemic control is crucial for kidney transplant recipients with diabetes, impacting morbidity and survival.
• Patients with diabetes and chronic kidney disease requiring insulin therapy may benefit from pancreas or islet transplantation.
• International policies and allocation systems influence the availability of pancreas/islet transplantation.

Purpose of the Study:

• To provide insights into candidate selection for pancreas/islet transplantation.
• To update on posttransplant outcomes for pancreas/islet recipients.
• To inform referring nephrologists on selection criteria and outcomes.

Main Methods:

• Review of current literature and transplant center practices.
• Analysis of factors influencing candidate selection, including age, comorbidities, and referral timing.
• Discussion of pretransplant evaluation and management of conditions like obesity and cardiovascular disease.

Main Results:

• Early referral (eGFR < 30 mL/min/1.73 m²) is vital for informed decision-making and evaluation.
• Addressing comorbidities like obesity, cardiovascular disease, and frailty is essential pre-transplant.
• Transplant options vary internationally due to regulatory and allocation policies.

Conclusions:

• Pancreas or islet transplantation should be considered for suitable diabetic kidney transplant candidates.
• Careful patient selection and pretransplant optimization are key to successful outcomes.
• Timely referral and comprehensive evaluation are critical for managing these complex patients.