Transplant Selection Criteria
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:
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.