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Transplantation Some Diabetes Patients May Benefit from Simultaneous Kidney-Pancreas Transplantation Patients with type 1 diabetes who progress to kidney failure may be candidates to receive a simultaneous kidney and pancreas transplant. “The expectation is that when these patients leave the hospital after a simultaneous pancreas and kidney transplant, they will no longer be on dialysis and will no longer be diabetic,” says Gerald Lipshutz, MD, surgical director of the UCLA Pancreas Transplant Program. STORY HIGHLIGHTS Patients most likely to be indicated for a combined kidney and pancreas transplant are those with brittle diabetes, patients with hypoglycemia unawareness and those whose lifestyle has been so adversely affected by their diabetes that they are willing to accept the risks of the procedure. While this provides patients the freedom from insulin therapy, the tradeoff, Dr. Lipshutz notes, is that patients must remain on medications to prevent transplant rejection post-surgery, and these immunosuppressant medications have significant side effects. Thus, UCLA physicians generally recommend the pancreas transplant only to patients who are also in need of a kidney transplant, or who already have received one. Attention also must be paid to the potential for cardiovascular complications as a result of the underlying diabetes. “These patients need to undergo an extensive workup with a cardiologist to make sure that if they do have a heart condition, it can be treated beforehand,” Dr. Lipshutz says. “Often, these patients don’t know they have underlying heart disease and we catch it during that process.” While the simultaneous pancreas and kidney transplant (often abbreviated SPK) is the most common performed at UCLA, the program also performs pancreas after kidney (PAK) transplant. The third category, pancreas transplant alone (PTA), is not commonly performed at UCLA, given the potential impact of the immunosuppressant drugs on kidneys, Dr. Lipshutz says. On a national level, combined kidney/ pancreas transplantation is being performed less frequently than in the past. “It was always appropriate only for a minority of type 1 diabetic UCLAHEALTH.ORG 1-844-4UCLADR (1-844-482-5237) patients,” says Gabriel Danovitch, MD, medical director of the UCLA Kidney and Pancreas Transplant Program. “But the demand is much lower than it used to be because of advances in our ability to control diabetes with strategies ranging from new insulin preparations to better insulin pumps. Given that this is a significant and high-risk surgical intervention, being able to control the diabetes through nonsurgical methods is always preferable.” Dr. Danovitch says that the patients most likely to be indicated for a combined kidney and pancreas transplant today are those with particularly hard-to-control diabetes — so- called brittle diabetics — and patients with hypoglycemia unawareness (a complication of diabetes in which sharp drops in blood sugar do not cause the symptoms associated with hypoglycemia, increasing the risk for seizures and other complications), as well as patients whose lifestyle has been so adversely affected by their diabetes that they are willing to accept the risks and undergo the procedure. For patients who are candidates, Dr. Lipshutz says, the combined kidney and pancreas transplant can be life changing. “These are individuals who have faced the abyss of diabetes and dialysis,” he explains. “They can’t eat a lot of salt because of their kidney failure, and they can’t take in a lot of sugar because of their diabetes. Following the procedure, they no longer require insulin or dialysis, and in general they can eat what they want, within moderation. Our team — the social workers, dietitian, nurse coordinators, nephrologists and myself — get to know these patients very well both before and after the procedure, and in most cases, they are extremely happy with the outcome.”