Kidney and kidney-pancreas transplantation in diabetic recipients.

Type 1 as well as Type 2 diabetic patients in end-stage renal failure and with no contraindications to kidney transplantation have a greater probability of survival with a functioning kidney graft than if they remain on dialysis. Five-year patient and pancreas graft survival rates for simultaneous kidney-pancreas transplantation are currently 81 and 67% respectively. The main benefit of this operation is to achieve insulin independence and improved quality of life. However, surgical morbidity is higher and the immunosuppressive regimen more powerful than for kidney transplantation alone. The 5-year survival rate for kidney transplantation in Type 2 patients without severe cardiovascular disease is 81%, although a high incidence of peripheral vascular complications can be expected. Renal transplantation should be considered in diabetic patients with a life expectancy of more than 5 years, no contraindications to immunosuppressive treatment, and low perioperative risk. Combined kidney-pancreas transplantation should be considered in Type 1 patients under 50 years of age with no or moderate cardiovascular complications and a thorough understanding of the risks and benefits of the procedure.