Abstract
Pancreas After Kidney (PAK) transplantation is a viable alternative to Simultaneous Pancreas and Kidney (SPK) transplantation if a suitable living kidney donor is available. In the PAK category, a living donor kidney transplant provides the best renal allograft survival, the possibility of potential preemptive renal transplantation, a much shorter period of time on the waitlist, and the subsequent deceased donor pancreas transplant results in freedom from diabetes. Additionally, if a pancreas-kidney recipient receives a living donor kidney, there is one more standard criteria kidney available for the deceased donor kidney transplant list. PAK after either a living or a deceased donor kidney transplant is associated with increased kidney graft survival compared with type 1 diabetic recipients who receive only a kidney. The best kidney allograft survival is for patients who receive a living donor kidney first. Receiving a living donor kidney is associated with increased pancreas allograft survival compared with receiving a deceased donor kidney. PAK transplant recipients who receive both organs have a survival advantage compared with uremic candidates who receive neither (SPK waitlist). In contrast to outdated analyses, successful PAK offers a survival advantage compared with receiving neither a kidney nor a pancreas transplant. Receiving a pancreas (after kidney) transplant may have a protective effect on the kidney allograft. The decline in PAK transplantation despite excellent outcome results is clearly the greatest contributor to the overall decreased volume in pancreas transplantation and also the greatest opportunity for improvement. PAK transplantation is an important treatment option for uremic recipients with diabetes.
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Nagaraju, S., Powelson, J.A., Fridell, J.A. (2023). Pancreas After Kidney Transplantation. In: Gruessner, R.W.G., Gruessner, A.C. (eds) Transplantation of the Pancreas. Springer, Cham. https://doi.org/10.1007/978-3-031-20999-4_23
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DOI: https://doi.org/10.1007/978-3-031-20999-4_23
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