Simultaneous pancreas-kidney transplantation: An overview of indications, complications, and outcomes

Simultaneous pancreas-kidney transplantation (SPK) has become an accepted t herapy for the treatment of patients with insulin-dependent diabetes mellit us and renal failure from diabetic nephropathy, The procedure has evolved o ver the last twenty years, and refinements in technique, better organ prese rvation solutions, and more potent immunosuppressive therapies have improve d one-year graft-survival rates to 81% for the pancreas and 88% for the kid ney (International Pancreas Transplant Registry Data-1996). Proper patient selection is important, given the increased complexity of the procedure, th e increased need for immunosuppression, and the need for compliance with po stoperative medications and monitoring. The benefits of a successful SPK in clude more physiologic glucose metabolism and freedom from dialysis. This r eview will describe the indications and selection process for potential can didates, outline the procedure and postoperative care, and discuss the pote ntial impact on secondary complications of diabetes mellitus. It will then discuss results and complications from the use of current protocols and imm unosuppression at the University of California at San Francisco.