Published online Aug 26, 2019. doi: 10.5500/wjt.v9.i4.81
Peer-review started: February 22, 2019
First decision: April 16, 2019
Revised: April 23, 2019
Accepted: July 29, 2019
Article in press: July 30, 2019
Published online: August 26, 2019
Processing time: 180 Days and 10.9 Hours
Kidney transplantation is the treatment of choice for management of end-stage renal disease. However, in diabetic patients, the underlying metabolic disturbance will persist and even may get worse after isolated kidney transplantation. Pancreatic transplantation in humans was first introduced in 1966. The initial outcome was disappointing. However, this was changed after the improvement of surgical techniques together with better patient selection and the availability of potent and better-tolerated immune-suppression like cyclosporine and induction antibodies. Combined kidney and pancreas transplantation will not only solve the problem of organ failure, but it will also stabilise or even reverse the metabolic complications of diabetes. Combined kidney and pancreas transplantation have the best long term outcome in diabetic cases with renal failure. Nevertheless, at the cost of an initial increase in morbidity and risk of mortality. Other transplantation options include pancreas after kidney transplantation and islet cell transplantation. We aim by this work to explore various options which can be offered to a diabetic patient with advanced chronic kidney disease. Our work will provide a simplified, yet up-to-date information regarding the different management options for those diabetic chronic kidney failure patients.
Core tip: Kidney transplantation is the treatment of choice for end-stage renal disease. Combined kidney-pancreas transplantation provides the patients with the highest long term survival. There are different surgical approaches for combined kidney-pancreas transplantation with recognised advantages and limitations of each technique. Islet cell transplantation is a minimally invasive treatment option but carries a risk of sensitisation to a wide range of human leukocyte antigen antigens.