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07-20-2018 | Type 1 diabetes | Review | Article

Simultaneous Pancreas-Kidney Transplantation Versus Living Donor Kidney Transplantation Alone: an Outcome-Driven Choice?

Journal: Current Diabetes Reports

Authors: Vishnu Swaroop Venkatanarasimhamoorthy, Adam D. Barlow

Publisher: Springer US



Purpose of Review

The choice of optimum transplant in a patient with type 1 diabetes mellitus (T1DM) and chronic kidney disease stage V (CKD V) is not clear. The purpose of this review was to investigate this in more detail—in particular the choice between a simultaneous pancreas-kidney transplantation (SPKT) and living donor kidney transplantation (LDKT), including recent evidence, to aid clinicians and their patients in making an informed choice in their care.

Recent Findings

Analyses of large databases have recently shown SPKT to have better survival rates than a LDKT in the long-term, despite an early increase in morbidity and mortality in SPKT recipients. This survival advantage has only been shown in those SPKT recipients with a functioning pancreas and not those who had early pancreas graft loss.


The choice of SPKT or LDKT should not be based on patient and graft survival outcomes alone. Individual patient circumstances, preferences, and comorbidities, among other factors should form an important part of the decision-making process. In general, an SPKT should be considered in those patients not on dialysis and LDKT in those nearing or already on dialysis.
Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation and recipients of first cadaveric transplant. N Engl J Med. 1999;341:1725–30. CrossRefPubMed
Matas AJ, Smith JM, Skeans MA, Lamb KE, Gustafson SK, Samana CJ, et al. OPTN/SRTR 2011 annual data report: kidney. Am J Transplant. 2013;13:11–46. CrossRefPubMed
Lamb KE, Lodhi S, Meier-Kriesche HU. Long-term renal allograft survival in the United States: a critical reappraisal. Am J Transplant. 2011;11:450–62. CrossRefPubMed
Fridell JA, Powelson JA, Sanders CE, Ciancio G, Burke GW 3rd, Stratta RJ. Preparation of the pancreas allograft for transplantation. Clin Transpl. 2011;25:E103–12. CrossRef
Heilman RL, Mazur MJ, Reddy KS. Immunosuppression in simultaneous pancreas-kidney transplantation: progress to date. Drugs. 2010;70:793–804. CrossRefPubMed
Israni AK, Feldman HI, Propert KJ, Leonard M, Mange KC. Impact of simultaneous kidney-pancreas transplant and timing of transplant on kidney allograft survival. Am J Transplant. 2005;5:374–82. CrossRefPubMed
Gruessner AC, Sutherland DE, Gruessner RW. Pancreas transplantation in the United States: a review. Curr Opin Organ Transplant. 2010;15:93–101. CrossRefPubMed
Salvalaggio PR, Dzebisashvili N, Pinsky B, Schnitzler MA, Burroughs TE, Graff R, et al. Incremental value of the pancreas allograft to the survival of simultaneous pancreas-kidney transplant recipients. Diabetes Care. 2009;32:600–2. CrossRefPubMedPubMedCentral
Morath C, Zeier M, Dohler B, Schmidt J, Nawroth PP, Opelz G. Metabolic control improves long-term renal allograft and patient survival in type 1 diabetes. J Am Soc Nephrol: JASN. 2008;19:1557–63. CrossRefPubMed
Young BY, Gill J, Huang E, Takemoto SK, Anastasi B, Shah T, et al. Living donor kidney versus simultaneous pancreas-kidney transplant in type I diabetics: an analysis of the OPTN/UNOS database. Clin J Am Soc Nephrol. 2009;4:845–52. CrossRefPubMedPubMedCentral
•• Barlow AD, Saeb-Parsy K, Watson CJE. An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK transplant registry study. Transpl Int. 2017;9:884–92. This large UK based registry study showed that there was no overall difference in patient survival between SPKT and LDKT. However, those SPKT recipients with a functioning pancreas graft at 90 days had significantly better patient survival and similar kidney graft survival to LDKT recipients CrossRef
Weiss AS, Smits G, Wiseman AC. Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation. Clin J Am Soc Nephrol. 2009;4:988–95. CrossRefPubMedPubMedCentral
Norman SP, Kommareddi M, Ojo AO, Luan FL. Early pancreas graft failure is associated with inferior late clinical outcomes after simultaneous kidney-pancreas transplantation. Transplantation. 2011;92:796–801. CrossRefPubMed
Hill M, Garcia R, Dunn T, Kandaswamy R, Sutherland DE, Humar A. What happens to the kidney in an SPK transplant when the pancreas fails due to a technical complication? Clin Transpl. 2008;22:456–61. CrossRef
Pascual J, Abramowicz D, Cochat P, Claas F, Dudley C, Harden P, et al. European renal best practice guideline on the management and evaluation of the kidney donor and recipient. Nefrologia. 2014;34:293–301. PubMed
Waki K, Sugawara Y, Kokudo N, Kadowaki T. Long-term pancreas allograft survival in simultaneous pancreas-kidney transplantation by era. Clin Transpl. 2012:13–22.
Becker BN, Brazy PC, Becker YT, Odorico JS, Pintar TJ, Collins BH, et al. Simultaneous pancreas-kidney transplantation reduces excess mortality in type 1 diabetic patients with end-stage renal disease. Kidney Int. 2000;57:2129–35. CrossRefPubMed
•• Pérez-Sáez MJ, Pascual J. Kidney transplantation in the diabetic patient. J Clin Med. 2015;6:1269–80. This comprehensive review looked at kidney and pancreas transplant options in patients with both type 1 and 2 diabetes and the outcomes of different treatment modalities CrossRef
Navarro X, Sutherland DE, Kennedy WR. Long-term effects of pancreas transplantation on diabetic neuropathy. Ann Neurol. 1997;42:727–36. CrossRefPubMed
Wang Q, Klein R, Moss SE, Klein BE, Hoyer C, Burke K, et al. The influence of combined kidney-pancreas transplantation on the progression of diabetic retinopathy. A case series. Ophthalmology. 1994;101:1071–6. CrossRefPubMed
Wilczek HE, Jaremko G, Tyden G, Groth CG. Evolution of diabetic nephropathy in kidney grafts. Evidence that a simultaneously transplanted pancreas exerts a protective effect. Transplantation. 1995;59:51–7. CrossRefPubMed
Boggi U, Rosati CM, Marchetti P. Follow-up of secondary diabetic complications after pancreas transplantation. Curr Opin Organ Transplant. 2013;18:102–10. CrossRefPubMed
Gruessner RW, Sutherland DE, Gruessner AC. Mortality assessment for pancreas transplants. Am J Transplant. 2004;4:2018–26. CrossRefPubMed
Venstrom JM, McBride MA, Rother KI, Hirshberg B, Orchard TJ, Harlan DM. Survival after pancreas transplantation in patients with diabetes and preserved kidney function. JAMA. 2003;290:2817–23. CrossRefPubMed
Gill JS, Tonelli M, Johnson N, Kiberd B, Landsberg D, Pereira BJ. The impact of waiting time and comorbid conditions on the survival benefit of kidney transplantation. Kidney Int. 2005;68:2345–51. CrossRefPubMed
Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation. 2002;74:1377–81. CrossRefPubMed
Huang E, Wiseman A, Okumura S, Kuo HT, Bunnapradist S. Outcomes of preemptive kidney with or without subsequent pancreas transplant compared with preemptive simultaneous pancreas/kidney transplantation. Transplantation. 2011;92:1115–22. CrossRefPubMed
Sureshkumar KK, Patel BM, Markatos A, Nghiem DD, Marcus RJ. Quality of life after organ transplantation in type 1 diabetics with end-stage renal disease. Clin Transpl. 2006;20:19–25. CrossRef
Isla Pera P, Moncho Vasallo J, Torras Rabasa A, et al. Quality of life in simultaneous pancreas-kidney transplant recipients. Clin Transpl. 2009;23:600–5. CrossRef
Ziaja J, Bozek-Pajak D, Kowalik A, Król R, Cierpka L. Impact of pancreas transplantation on the quality of life of diabetic renal transplant recipients. Transplant Proc. 2009;41(8):3156–8. CrossRefPubMed
Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective quality-of-life monitoring of simultaneous pancreas and kidney transplant recipients using the 36-item short form health survey. Am J Kidney Dis. 2010;55:698–707. CrossRefPubMed
Shah AP, Mangus RS, Powelson JA, Samy KP, Taber TE, Goble ML, et al. Impact of recipient age on whole organ pancreas transplantation. Clin Transpl. 2013;27:E49–55. CrossRef
Schenker P, Vonend O, Kruger B, et al. Long-term results of pancreas transplantation in patients older than 50 years. Transpl Int. 2011;24:136–42. CrossRefPubMed
Ablorsu E, Ghazanfar A, Mehra S, Campbell B, Riad H, Pararajasingam R, et al. Outcome of pancreas transplantation in recipients older than 50 years: a single-centre experience. Transplantation. 2008;86:1511–4. CrossRefPubMed
Sampaio MS, Reddy PN, Kuo HT, Poommipanit N, Cho YW, Shah T, et al. Obesity was associated with inferior outcomes in simultaneous pancreas kidney transplant. Transplantation. 2010;89:1117–25. CrossRefPubMed
Afaneh C, Rich B, Aull MJ, Hartono C, Kapur S, Leeser DB. Pancreas transplantation considering the spectrum of body mass indices. Clin Transpl. 2011;25:E520–9. CrossRef
Fridell JA, Mangus RS, Taber TE, Goble ML, Milgrom ML, Good J, et al. Growth of a nation part II: impact of recipient obesity on whole-organ pancreas transplantation. Clin Transpl. 2011;25:E366–74. CrossRef
Shapiro AM, Lakey JR, Ryan EA, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000;343:230–8. CrossRefPubMed
Kandaswamy R, Sutherland DE. Pancreas versus islet transplantation in diabetes mellitus: how to allocate deceased donor pancreata? Transplant Proc. 2006;38:365–7. CrossRefPubMed
Gerber PA, Pavlicek V, Demartines N, Zuellig R, Pfammatter T, Wüthrich R, et al. Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5 year single centre follow-up. Diabetologia. 2008;51:110–9. CrossRefPubMed
Gerber PA, Locher R, Zuellig RA, Tschopp O, Ajdler-Schaeffler E, Kron P, et al. Glycemia, hypoglycemia, and costs of simultaneous islet-kidney or islet after kidney transplantation versus intensive insulin therapy and waiting list for islet transplantation. Transplantation. 2015;99(10):2174–80. CrossRefPubMed
Eleni B, Konstantinos K, Hood T, Martin T, Eleni A, Thomas K, et al. Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis. BMJ. 2018;361:k1310.
Wiseman AC. Kidney transplant options for the diabetic patient. Transplant Rev (Orlando). 2013;27:112–6. CrossRef

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