Indications & Contraindications
The clinical practice recommendations of the American Diabetes Association state that a pancreas transplant (Simultaneous Kidney and Pancreas Transplant [SPK] or Pancreas After Kidney Transplant [PAK]is an acceptable surgical procedure in type 1 diabetic patients also undergoing kidney transplantation. These must be in medically suitable type 1 diabetic patients who are also renal transplant candidates or who have excellent function of a kidney transplant who are interested in receiving a pancreas transplant. The vast majority of pancreas transplants are performed as an SPK followed by PAK.
Pancreas transplantation can be performed in type 1 diabetics who have preserved native kidney function but suffer from glucose lability and frequent, acute and severe metabolic complications including repeated episodes of ketoacidosis, have incapacitating clinical and emotional problems related to insulin therapy, and have consistent failure of insulin therapy to prevent acute diabetic complications. Significant hypoglycemic unawareness may also be an indication as achieving an insulin-free state enhances their quality of life. Pancreas transplantation alone [PTA] should be performed before secondary complications of diabetes become irreversible and before the need for a kidney transplant . A creatinine clearance above 60 to 70 mL/min is usually required as immunsouppressants can cause accelerated deterioration of native renal function in patients with a lower creatinine clearance. This type of transplant represents the smallest number of the three.