Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Table 1 Current indications and contraindications for simultaneous pancreas-kidney in type 1 diabetes mellitus[11,12,15]

Current indications for SPK in T1DM

Confirmed diabetic nephropathy with low or absent C-peptide, on insulin treatment

Creatinine clearance < 15 mL/min or on dialysis

Presence of other microvascular or macrovascular complications of T1DM

Ability to withstand immunosuppression and surgery

History of compliance with medical advice and treatment

Absolute contraindications for SPK in T1DM

Significant cardiovascular disease with severe or non-correctable coronary artery disease

Cardiac ejection fraction < 50%

Recent myocardial infarction

Non-curable malignancy except localized skin cancer

Active sepsis

Active peptic ulcer disease

Severe mental health conditions that can lead to non-compliance

Inability to survive surgery or immunosuppression due to significant comorbidity

Relative contraindications for SPK in T1DM

Cerebrovascular event with long-standing impairment

Human immunodeficiency virus, hepatitis B and C virus infections

BMI > 30 kg/m2

Age > 60 yrs

Extensive vascular, aortic, and renal artery disease (making surgery high-risk)

Excessive need for insulin > 1.5 U/kg/d

Continuous use of alcohol, smoking, and other drugs

T1DM: Type 1 diabetes mellitus; SPK: Simultaneous pancreas-kidney.