Transplantation as a therapeutic option for diabetic nephropathy

Diabetic nephropathy affects both type I and type 2 diabetic patients with a frequency of 20-30%. The first sign is microalbuminuria within a range of 30-300 mg/24h, frequently evolving towards frank proteinuria and renal failure. Tight glucose control, control of arterial hypertension with the use of ACEi or ARB can retard progression. Once renal failure is established, kidney transplantation can be considered for type I and type 2 diabetic patients. Quality of life and survival are improved with this procedure. In type I diabetes, simultaneous grafting of a kidney and pancreas considerably improves quality of life and diabetic complications. Surgical and infectious complications are sporadic drawbacks of this procedure. Pancreas transplantation alone (PTA) remains controversial, since a retrospective study in 2003 by Venstrom concluded that survival for PTA patients is worse than for comparable patients remaining on the waiting list. PTA can be considered for type I diabetic patients without advanced renal failure with severe and frequent metabolic instability (hypoglycaemia, ketoacidosis). Islet transplantation is still an experimental but promising procedure in highly selected patients, avoiding major abdominal surgery.