Kidney transplantation or simultaneous kidney-pancreas transplantation in diabetic patients: indications, advantages and possible complications

Diabetic nephropathy is one of the main causes of renal failure and inclusion in a dialysis and transplant program. Kidney allograft can be made from a living or cadaver donor. Using living kidney transplant permits an early or preventive transplantation as compared to cadaver kidney allograft transplantation, which can be performed either as a single organ or combined with a pancreas transplantation. The choice of any kind of transplantation modality depends on age, type of diabetes and state of chronic diabetic complications. Each transplant modality has its advantages and disadvantages. Single kidney allograft is technically easier and less immunogenic, but it not allows complete metabolic control that can be achieved with simultaneous pancreas transplantation. The early complications are more frequent with kidney-pancreas transplant. But in the long-term, carbohydrate metabolism normalization achieved by the functioning pancreas allograft avoids recurrence of nephropathy in the kidney allograft, improves neuropathy and decreases cardiovascular mortality.