Advertisement

Simultaneous Pancreas and Kidney Transplantation—Is It a Treatment Option for Patients With Type 2 Diabetes Mellitus? An Analysis of the International Pancreas Transplant Registry

  • Angelika C. GruessnerEmail author
  • Mark R. Laftavi
  • Oleh Pankewycz
  • Rainer W. G. Gruessner
Immunology, Transplantation, and Regenerative Medicine (L Piemonti and V Sordi, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Immunology, Transplantation, and Regenerative Medicine

Abstract

Purpose of Review

Pancreas transplantation remains the best long-term treatment option to achieve euglycemia and freedom from insulin in patients with labile diabetes mellitus. It is an approved procedure for type 1 (T1DM), but it is still considered controversial for type 2 diabetes mellitus (T2DM).

Recent Findings

This study analyzed all primary deceased donor pancreas transplants in patients with T2DM reported to IPTR/UNOS between 1995 and 2015. Characteristics, outcomes, and risk factors over time were determined using univariate and multivariate methods. The focus was on simultaneous pancreas/kidney (SPK) transplants, the most common pancreas transplant category. Patient, pancreas, and kidney graft survival rates increased significantly over time and reached 95.8, 83.3, and 91.1%, respectively, at 3 years posttransplant for transplants performed between 2009 and 2015.

Summary

SPK is a safe procedure with excellent pancreas and kidney graft outcome in patients with T2DM. The procedure restores euglycemia and freedom from insulin and dialysis. Based on our results, SPK should be offered to more uremic patients with labile T2DM.

Keywords

Pancreas transplants Kidney transplants Patient survival Graft function Type 2 diabetes mellitus Risk factors 

Notes

Compliance With Ethical Standards

Conflict of Interest

Angelika C. Gruessner, Mark R. Laftavi, Oleh Pankewycz, and Rainer W.G. Gruessner declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • American Diabetes A. 2. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(Suppl 1):S13–22. Helpful new guidelines for the classification of diabetes type. Google Scholar
  2. 2.
    Panunzi S, et al. Determinants of diabetes remission and glycemic control after bariatric surgery. Diabetes Care. 2016;39(1):166–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Wiseman AC, Gralla J. Simultaneous pancreas kidney transplant versus other kidney transplant options in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2012;7(4):656–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Sampaio MS, Kuo HT, Bunnapradist S. Outcomes of simultaneous pancreas-kidney transplantation in type 2 diabetic recipients. Clin J Am Soc Nephrol. 2011;6(5):1198–206.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sasaki TM, et al. Successful long-term kidney-pancreas transplants in diabetic patients with high C-peptide levels. Transplantation. 1998;65(11):1510–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Cantarovich D, et al. Simultaneous pancreas and kidney transplantation in a type II (non-insulin-dependent) diabetic uremic patient requiring pregraft insulin therapy. Transplant Proc. 1990;22(2):662.PubMedGoogle Scholar
  7. 7.
    Friedman AL, Friedman EA. Pancreas transplantation for type 2 diabetes at U.S. transplant centers. Diabetes Care. 2002;25(10):1896.CrossRefPubMedGoogle Scholar
  8. 8.
    Saudek F, et al. Maturity-onset diabetes of the young with end-stage nephropathy: a new indication for simultaneous pancreas and kidney transplantation? Transplantation. 2004;77(8):1298–301.CrossRefPubMedGoogle Scholar
  9. 9.
    Light JA, Barhyte DY. Simultaneous pancreas-kidney transplants in type I and type II diabetic patients with end-stage renal disease: similar 10-year outcomes. Transplant Proc. 2005;37(2):1283–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Chakkera HA, et al. Outcomes after simultaneous pancreas and kidney transplantation and the discriminative ability of the C-peptide measurement pretransplant among type 1 and type 2 diabetes mellitus. Transplant Proc. 2010;42(7):2650–2.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    •• Gruessner AC, Gruessner RW. Pancreas transplantation of US and non-US cases from 2005 to 2014 as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2016;13(1):35–58. Newest overview over the development of pancreas transplantation. CrossRefPubMedGoogle Scholar
  12. 12.
    Gruessner AC, Gruessner RW. Long-term outcome after pancreas transplantation: a registry analysis. Curr Opin Organ Transplant. 2016;21(4):377–85.CrossRefPubMedGoogle Scholar
  13. 13.
    •• Orlando G, Stratta RJ, Light J. Pancreas transplantation for type 2 diabetes mellitus. Curr Opin Organ Transplant. 2011;16(1):110–5. General overview about pancreas transplantation in patients with T2DM. CrossRefPubMedGoogle Scholar
  14. 14.
    Singh RP, et al. Do pretransplant C-peptide levels influence outcomes in simultaneous kidney-pancreas transplantation? Transplant Proc. 2008;40(2):510–2.CrossRefPubMedGoogle Scholar
  15. 15.
    •• Mittal S, Gough SC. Pancreas transplantation: a treatment option for people with diabetes. Diabet Med. 2014;31(5):512–21. General overview about pancreas transplantation in patients with T2DM. CrossRefPubMedGoogle Scholar
  16. 16.
    Gruessner AC. 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2011;8(1):6–16.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kleinclauss F, et al. Pancreas after living donor kidney transplants in diabetic patients: impact on long-term kidney graft function. Clin Transpl. 2009;23(4):437–46.CrossRefGoogle Scholar
  18. 18.
    • Neidlinger N, et al. Incidence of and risk factors for posttransplant diabetes mellitus after pancreas transplantation. Am J Transplant. 2010;10(2):398–406. This work provides a nice overview about risk factors for post-transplant diabetes mellitus which is especially important for patients with T2DM. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Angelika C. Gruessner
    • 1
    Email author
  • Mark R. Laftavi
    • 1
  • Oleh Pankewycz
    • 2
  • Rainer W. G. Gruessner
    • 1
  1. 1.Department of SurgerySUNY Upstate Medical UniversitySyracuseUSA
  2. 2.Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseUSA

Personalised recommendations