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Updated: Feb 10, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Case Report: Simultaneous pancreas-kidney transplantation in MELAS: first reported case with 5-year follow-up
Vera Nilsén1,2, Julia Bojstedt3, Johan Nordström1,2
1Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Background:
Mitochondrial encephalomyopathy with lactic acidosis, and stroke-like episodes (MELAS) is a rare mitochondrial DNA disorder that, in severe cases, can result in insulin-dependent diabetes and end-stage renal disease (ESRD). While organ transplantation is a potential treatment, documented cases remain scarce.
Methods:
A 40-year-old patient with dialysis-dependent ESRD and diabetes secondary to MELAS underwent simultaneous pancreas-kidney transplantation. The perioperative and postoperative periods were uncomplicated with only targeted MELAS-specific adaptations to standard protocols.
Results:
During the 5-year follow-up, the patient maintained excellent kidney allograft function and sustained insulin independence, with no need for dialysis or exogenous insulin therapy. At 5 years, creatinine was 77 µmol/L with an estimated GFR above 90 mL/min/1.73 m2, and glycated hemoglobin was 40 mmol/mol.
Conclusions:
SPK transplantation may be feasible in carefully selected patients with MELAS, ESRD, and diabetes, providing durable renal and metabolic graft function at 5 years. To our knowledge, this is the first reported SPK case in MELAS, with extended follow-up.
Insights
Simultaneous pancreas-kidney transplantation may be a viable option for patients with MELAS, end-stage renal disease, and diabetes. This approach demonstrated successful long-term kidney and metabolic function in a single case study.
Area of Science:
- Nephrology
- Endocrinology
- Mitochondrial Diseases
Background:
- Mitochondrial encephalomyopathy with lactic acidosis, and stroke-like episodes (MELAS) is a rare genetic disorder.
- Severe MELAS can lead to insulin-dependent diabetes and end-stage renal disease (ESRD).
- Organ transplantation is a potential treatment, but documented cases are limited.
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