Pancreas transplant options for patients with type 1 diabetes mellitus and chronic kidney disease: simultaneous pancreas kidney or pancreas after kidney?

Purpose of review For patients with type 1 diabetes and chronic kidney disease, the benefits of kidney transplantation vs. dialysis have long been appreciated. However, until recently, the added benefit of pancreas transplantation has been less well defined. Recent findings A number of articles now suggest a long-term survival advantage with simultaneous pancreas kidney (SPK) transplantation, with concurrent improvements in pancreas after kidney transplantation. Although supportive of pancreas transplantation as the preferred therapy for this population, this creates a difficult decision-making process for the patient with type 1 diabetes mellitus and a living donor: should one proceed with living donor transplant and consider pancreas transplantation subsequently, or should one wait for an SPK transplant? Summary The purpose of this review is to synthesize current data regarding pancreas treatment options and couple this with a discussion of current organ utilization to better understand the advantages and disadvantages of each of these strategies. This in turn may inform clinicians and aid in counseling for the individual patient.