Kidney Pancreas Transplant, a Brief Comprehension to Care

Abstract

Surgical treatments for Insulin Dependent Diabetes Mellitus (IDDM) complicated with Advanced Chronic Kidney Disease (CKD) have emerged with the hope of providing a better sustainable quality of life. This article aims to highlight the utility of kidney and pancreas transplant in the management of IDDM with renal failure. There are different surgical methodologies, of which Simultaneous Pancreas And Kidney Transplantation (SPK) has been the most promising; in terms of graft survival and decreasing the need for a second surgical intervention in terms of kidney transplant. However, long waiting lists to find matching donors and post-operative complications are the most challenging obstacles. All recipients shall be screened for anti-HLA antibodies, non-HLA antibodies and Coronary Heart Disease (CHD). The presence of CHD poses a mortality risk post-surgery. Recipient selection requires a meticulous insight based on the insulin requirements, with the fact that not all will achieve insulin independence. A donor’s risk factors must be estimated by the Pancreas Donor Risk Index (PDRI), the higher the score lower the chances of graft survival. Pancreatic graft failure has no unanimously agreed definition of rejection and is dependent on a variety of donor and recipient factors. Close follow up and a high index of suspicion for any unexplained signs or symptoms is required to detect early allograft rejection, and the consideration of other surgical and medical etiologies is also required. This mini review will discuss various options for the management of insulin dependent diabetics whose diabetes remain uncontrolled with maximal efforts and have developed advanced chronic kidney disease pending renal replacement.