Simultaneous kidney and pancreas transplantation: Current trends and challenges

Diabetes is a widespread disease affecting millions of people, making it one of the leading causes of death in the world. It is a leading cause of cardiovascular disease and end-stage renal disease. Despite advancements in treatment, including insulin therapy and glucose monitoring devices, diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression. While traditionally indicated for type 1 diabetes, recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria. These transplants are usually a part of a simultaneous kidney-pancreas transplant. However, although less frequently performed, transplants of pancreas alone or pancreas after kidney transplant are still available. For selected diabetic patients, pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications; however, they are not without risks. Complications such as bleeding, vascular thrombosis, infection, organ leak, and rejection are possible. Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available high-quality allografts and resource constraints of transplant centers. Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.