Individuals who have insulin dependent diabetes accompanied by advanced, chronic renal failure, or who are on dialysis may be good candidates for a simultaneous pancreas and kidney transplant (SPK). SPK is a transplant procedure where both a kidney and a pancreas are transplanted at the same time using organs from a deceased donor. The procedure frees patients from dialysis and insulin dependency.

Patients who are eligible for SPK typically have:

• Documented insulin dependent diabetes mellitus, including a history of juvenile onset and brittle diabetes with episodes of hypoglycemia or diabetic ketoacidosis.
• Secondary diabetic complications despite appropriate medical management. These complications include:
• • Diabetic retinopathy
  • Diabetic neuropathy
  • Diabetic gastroparesis
  • Accelerated atherosclerosis

Individuals who have insulin dependent diabetes and a documented progression of secondary complications, despite intensive medical intervention may be eligible for either a pancreas transplant alone (PTA) or a pancreas transplant after a kidney transplant (PAK). Among their symptoms are:

• Progression of secondary diabetic complications, such as:
• • Diabetic retinopathy
  • Diabetic peripheral or automatic neuropathy
  • Diabetic gastroperesis
  • Progressive atherosclerosis
• Neuroglycopenia with unawareness
• Recurrent diabetic ketoacidosis
• Actual 24-hour urine collection that has creatinine clearance greater than or equal to 40 cc/minute and proteinuria of less than one gram (PAK)
• Actual 24-hour urine collection that has creatinine clearance greater than or equal to 60 cc/minute and proteinuria of less than 1 gram (PTA)

Patients are not good candidates for pancreas transplantation if they have:

• Malignancy within the past two years (other than skin)
• Cardiovascular or pulmonary disease sufficiently severe to prevent surgery
• A positive test for human immunodeficiency virus (HIV)
• Active infection
• A body mass index of more than 30
• Active alcohol or substance abuse (must be abstinent for six months and have successfully completed a treatment program)

No smoking is strongly advocated for all potential pancreas transplant patients.