[Pancreas Transplantation]

Simultaneous pancreas-kidney transplantation (SPK) is the only established therapy of type 1 diabetes mellitus with diabetic nephropathy and preterminal/terminal kidney failure. Despite a high demand, with 551 patients on the waiting list in Germany in 2022, only about 42 pancreas transplants were performed in that year. As a result, with waiting times of 2-3 years, there is a significant number of deaths among patients on the waiting list. In addition to SPK, isolated pancreas transplantation (IPT) and pancreas transplantation after kidney transplantation (PAK) are only considered for specific indications. Strict selection criteria are essential, as patients with longstanding type 1 diabetes often have cardiovascular comorbidities, leading to an increased risk profile for intra- and postoperative complications. Donor selection is challenging, due to limited organ availability, and strict quality requirements. Improved training in highly specialised centres could help to maintain surgical expertise. Despite high perioperative and postoperative complication rates, SPK has favourable long-term outcomes, with an average graft survival of over 12 years, thus significantly improving long-term patient survival. SPK remains the gold standard for curing type 1 diabetes mellitus, but structural adaptations are needed to ensure its long-term implementation.