Kidney Transplantation in the Diabetic Patient

Abstract

Diabetes mellitus is one of the most important causes of chronic kidney disease (CKD). In patients with advanced diabetic kidney disease, kidney transplantation (KT) with or without a pancreas transplant is the treatment of choice. We aimed to review current data regarding kidney and pancreas transplant options in patients with both type 1 and 2 diabetes and the outcomes of different treatment modalities. In general, pancreas transplantation is associated with long-term survival advantages despite an increased short-term morbidity and mortality risk. This applies to simultaneous pancreas kidney transplantation or pancreas after KT compared to KT alone (either living donor or deceased). Other factors as living donor availability, comorbidities, and expected waiting time have to be considered whens electing one transplant modality, rather than a clear benefit in survival of one strategy vs. others. In selected type 2 diabetic patients, data support cautious utilization of simultaneous pancreas kidney transplantation when a living kidney donor is not an option. Pancreas and kidney transplantation seems to be the treatment of choice for most type 1 diabetic and selected type 2 diabetic patients.

Keywords: diabetes; kidney transplantation; survival.

Figure 1

Diabetic patient treatment management proposed algorithm. eGFR, estimated glomerular filtration rate; LDKT, living donor kidney transplant; DDKT, deceased donor kidney transplant; SPK, simultaneous pancreas-kidney; PAK, pancreas after kidney; HD, hemodialysis; PD, peritoneal dialysis; ESRD, end-stage renal disease.