The Authors’ Reply: Type 2 Diabetes and Simultaneous Pancreas-kidney Transplantation
We thank Singh et al1 for their letter highlighting the practice of listing a minority of highly selected candidates with end-stage kidney disease (ESKD) caused by type 2 diabetes (T2D) for simultaneous pancreas-kidneys (SPKs) transplantation. As noted, we recommended that candidates with ESKD and type 1 diabetes (T1D) or T2D be considered for kidney transplantation (grade 1B), then suggested that “candidates with ESKD and T1D be considered for SPK transplantation (grade 2A).”2 We intentionally omitted consideration of SPK transplantation for T2D given the lesser evidence base for this practice, the more nuanced indications, and regional differences in the acceptance of this practice. As documented by Singh et al, this practice is common in the United States, though far less so in other countries. This point highlights 2 key principles underlying our guideline: (1) we considered multiorgan transplantation to be beyond the scope of this guideline (see Scope, pS4) but suggested SPK for T1D given the importance of this consideration and the evidence base in favor of it and (2) though the KDIGO guideline is international in nature, it still requires consideration of the local context in its implementation. In this vein, consideration of SPK for T2D in the United States is a good illustration of this principle.
1. Singh N, Parsons R, Lentine K, et al. Simultaneous pancreas kidney transplantation for type 2 diabetes mellitus. Transplantation. 2021. In press.
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2. Kidney Disease: Improving Global Outcomes (KDIGO) Kidney Transplant Candidate Work Group. KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation. 2020;104:S1–S103.