Survival Advantage of Kidney-Pancreas vs. Kidney Alone Transplant in the Modern Era

Purpose of Review: There is a well-defined knowledge of relative benefits of pancreas transplants to patients with respect to specific diabetic complications; however, the degree of survival advantage of a simultaneous pancreas and kidney versus kidney transplant alone in the type I diabetes mellitus patient population remains controversial. Recent Findings: At the crux of the issue, it remains that there is no randomized, controlled study on this topic. Moreover, the information that does exist is limited by inherent selection biases despite the most robust forms of statistical analysis in order to correct for the known issues within the data. Over time, studies have restricted group analyses to try to remove some of these biases. Summary: While there is an increase in morbidity and mortality early on with pancreas transplantation, most studies have suggested that there is probably a modestly improved long-term outcome in simultaneous kidney-pancreas over kidney transplant alone. In the absence of better data, candidate selection for kidney-pancreas transplantation should be guided towards individual needs and preferences, taking into consideration surgical risk, quality of life, potential for impact on secondary complication of diabetes, and desire to optimize outcomes.