Pancreas before Kidney Transplant in Diabetic Patients with Uremia

Theoretically, pancreas before kidney transplant (PBK) could also be one of the options for those waiting for both pancreas and kidney grafts, but it has never been reported. This study is to clarify the justification and feasibility of PBK. There were 160 cases of pancreas transplant in this study, including 26 (16%) PBK. Rejection (3.8%) of pancreas graft was significantly lower in PBK group, followed by 16.7% in pancreas after kidney transplant (PAK), 29.8% in simultaneous pancreas and kidney transplant (SPK) and 37.0% in pancreas transplant alone (PTA). There was no chronic rejection in PBK and PAK groups. Fasting blood sugar and serum HbA1c levels after PBK were not significantly different from those by other subgroups. The serum C-peptide levels were significantly higher in PBK group than those by other subgroups. The 5-year pancreas graft survival was 100% for PBK and PAK, 97.0% for SPK and 77.9% for PTA. In conclusion, PBK could be a treatment option for patients with diabetes complicated by end-stage renal disease (ESRD) in terms of surgical risks, endocrine function, and immunological and graft survival outcomes. However, given the inferior patient survival outcome, PBK is still not recommended unless SPK and PAK is not available.