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.
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).
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.