transplant

transplant

1 Simultaneous pancreas–kidney transplant (SPK) . Both organs come from the same deceased donor. - This is the commonest type of pancreas transplant and is indicated in patients with chronic renal failure (on or close to requiring dialysis) secondary to diabetes. 2 Pancreas transplant alone (PTA) . Primarily for patients with type 1 diabetes who have repeated epi - sodes of hypoglycaemia associated with unawareness (i.e. patients develop hypoglycaemic coma without warning). This is a life-threatening situation and suc h patients are employment. 3 Pancreas-after-kidney transplant (PAK) Deceased donor pancreas transplantation is performed after a previous kidney transplant, from either a living or deceased donor. 4 Simultaneous deceased donor pancreas and live donor kidney transplant . This option may shorten waiting times but is logistically very challenging and rarely performed. Transplantation of the islets of Langerhans (islet cell transplant) is an alternative to pancreas transplant alone for patients with hypoglycaemic unawareness. This is not a solid organ transplant and theref ore not detailed in this chapter, but a brief description follows. After pancreas retrieval, islets are isolated, prepared and delivered into the portal vein (PV) of the recipient, usually via a percutaneous transhepatic radio logically guided procedure. Early results demonstrated that the presence of functioning islets appeared to protect against refractory hypoglycaemia and improve glycaemic control b with a low incidence of insulin independence. However, suc cess rates have improved in the last decade with some series showing 50% of patients remaining insulin independent at 5 /uni00A0 years. Imm unosuppression is required for islet transplanta tion and the associated long-term risks need to be balanced with the treatment benefits.