Types of Procedures

There are three groups of patients that are considered for pancreas transplantation.  First is the simultaneous kidney and pancreas transplantation (or SPK) for diabetics who are in renal failure.  This is generally the preferred method of pancreas transplantation having the advantage of only one surgical intervention and one source of foreign HLA for the recipient patient. 

Second is pancreas after kidney transplant (or PAK) for diabetic patients who already have a functioning kidney allograft.  Immunosuppressive therapy is not a major concern as patients are already immunosuppressed for their kidney allograft.  The main risk to the patient is the alteration in immunosuppression necessary after pancreas transplantation and the inherent risks of an intraabdominal surgical procedure.  In general, type 1 diabetic patients undergoing living or cadaveric renal transplantation should have their kidney placed on the left side in anticipation of a pancreas transplant in the future. 

Third is the pancreas transplantation alone (or PTA).  This is a therapeutic option of the preuremic patient with none to minimal renal dysfunction who has brittle diabetic management despite the administration of conventional antidiabetic therapies and hypoglycemic unawareness.  The main risks to these patients are the long-term effects of chronic immunosuppression and the surgical procedure itself.  patients.