The influence of pancreas after kidney transplantation on patient survival and kidney allograft function

Purpose of review Pancreas transplantation after kidney transplantation improves the quality of life of kidney transplant recipients by removing the exogenous need for insulin and decreasing the number of hypoglycemic events. Recent studies have raised concern, however, over the potential negative impact of pancreas after kidney transplantation. This paper reviews the influence of pancreas after kidney transplantation on patient survival and kidney allograft function. Recent findings Two recent retrospective reviews examined the effects of pancreas after kidney transplantation on patient survival. A survival disadvantage was reported for recipients of pancreas after kidney transplants at both 1 and 4 years compared with those on the waiting list for a pancreas transplant. Another study examined the survival benefit of pancreas after kidney transplantation in a recent cohort of patients with current follow-up and found neither a survival advantage nor disadvantage between recipients of pancreas after kidney transplants and wait-listed patients. Other researchers demonstrated that pancreas after kidney transplantation had a negative impact on preexisting renal allograft function. Summary Despite improving quality of life, pancreas after kidney transplantation also increases the short-term mortality rate, although this risk is eliminated with long-term follow-up. In addition, pancreas after kidney transplantation can be detrimental to the survival and function of the kidney allograft, but judicious selection of patients with adequate renal function for the pancreas after kidney transplantation procedure seems to void this risk.