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Pancreas after kidney transplantation: why is the most logical option the least popular?

Fridell, Jonathan A.; Powelson, John A.

Current Opinion in Organ Transplantation: February 2015 - Volume 20 - Issue 1 - p 108–114
doi: 10.1097/MOT.0000000000000160
PANCREAS TRANSPLANTATION: Edited by Jonathan A. Fridell

Purpose of review Despite recent improvements in outcomes for pancreas transplantation in general, including graft survival following pancreas after kidney (PAK) transplantation, there has been a consistent decline in the number of PAK transplants performed in the USA. The purpose of the present review is to analyze the advantages and disadvantages of PAK transplantation compared with simultaneous pancreas and kidney (SPK) transplantation and to review recent publications in an attempt to explain this phenomenon.

Recent findings PAK transplantation has historically been associated with inferior pancreas allograft survival compared with SPK transplantation. Under modern immunosuppression protocols, pancreas allograft survival has improved substantially with rare immunological graft loss. According to several recent publications, it is controversial whether there is a survival advantage related to performing the pancreas transplant once the recipient has had a living donor renal transplant (LDRTx).

Summary Considering that patient survival following SPK transplantation is significantly superior to that of recipients of LDRTx with type 1 diabetes alone and that LDRTx has demonstrated clear superiority in terms of renal allograft and patient survival over cadaveric renal transplantation, it would seem that PAK transplantation should be revisited as the option of choice for uremic recipients with diabetes.

Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA

Correspondence to Jonathan A. Fridell, MD, FRCSC, Director of Pancreas Transplantation, Professor of Surgery, Indiana University School of Medicine, 550 N University Blvd, #4258, Indianapolis, IN 46202, USA. Tel: +1 317 944 4370; fax: +1 317 944 3268; e-mail: jfridell@iupui.edu

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