Pancreas - kidney transplantation : clinical , metabolic and immunological outcomes

The first pancreas transplant was performed in 19661 and since then much has evolved. Refinements in surgical technique, immunosuppressive protocols and postoperative care have led to progressively improved outcomes. These results have encouraged many transplant centres to implement pancreas transplant programmes. Simultaneous pancreas-kidney transplantation (SPKT) has better mediumand long-term results than pancreas after kidney or pancreas transplantation alone. Based on this, since 2000 the American Diabetes Association has recommended SPKT as the pancreas transplantation modality of choice for type-1 diabetes (DM1) patients with end-stage renal disease2,3. Pancreas after kidney transplantation is another option, especially for recipients having a living kidney donor. Pancreas transplantation alone remains restricted for those with minor renal disease and labile diabetes, with history of frequent ketoacidosis or hypoglycaemic coma episodes3. In recent years and mainly in the United States, some type-2 diabetes patients have also been considered for pancreas transplantation, following a very narrow selection process.