We consult one-on-one with patients and their families to determine the best option:

COMBINED KIDNEY-PANCREAS TRANSPLANTS FOR PATIENTS WHO HAVE TYPE 1 DIABETES AND SIGNIFICANT KIDNEY DISEASE

There are two types of combined kidney-pancreas transplant – Simultaneous Pancreas and Kidney Transplant (SPK) and Pancreas after Kidney Transplant (PAK)

• Simultaneous Pancreas and Kidney Transplant (SPK): Where both transplanted organs come from the same deceased donor. During the same operation, patients receive a kidney and pancreas transplantation. For many diabetics with kidney failure, this procedure provides the greatest hope for a life without dialysis or insulin injections.
• Pancreas after Kidney Transplant (PAK) : Where the patient will have a living kidney donor so the kidney transplant is performed first, using the living donor's kidney. Then, the patient waits for a deceased donor pancreas to become available.

PANCREAS TRANSPLANT ALONE (PTA)

Pancreas-only transplant is considered for people with type 1 diabetes who have healthy kidney function. When type 1 diabetes cannot be controlled (brittle diabetes) or causing serious problems (hypoglycaemic unawareness or coma), a patient may want to think about pancreas transplantation. Nearly all patients who receive a pancreas from a deceased donor no longer need insulin shots. Their risk for kidney disease and other diabetic complications may also be lower after a transplant.

Before transplant, the following tests are performed:

• Blood tests
  
• Chest X-ray within the last year.
• Creatinine clearance testing for those not on dialysis. This test, conducted over a 24-hour period, compares how much creatinine — a blood waste product — occurs in the blood and in the urine to evaluate kidney function.
• Electrocardiogram (EKG or ECG) and echocardiogram within the last year.
• Dobutamine stress echocardiogram or Myocardial perfusion scan. In some cases a coronary angiogram may be needed.
• Doppler evaluation of lower limb arteries
• Tuberculosis (TB) skin test.
• Other tests may be required — depending on gender, age and medical history — such as a colonoscopy, mammogram, Pap smear or prostate specific antigen (PSA) test.

Success rates for these transplant operations are high. Patients who remain free of rejection for the first year have a high likelihood of keeping their organ for one or more decades.

A pancreas transplant can have a positive effect on the secondary complications of diabetes. Some of the improvements that may be experienced include a reversal of nerve damage and cardiovascular complications caused by diabetes. It can also stop the progression of retinal degeneration, which causes blindness in people with type 1 diabetes. Pancreas transplant improves the quality of life for people with type 1 diabetes with end-stage kidney disease above that which can be accomplished by kidney transplant alone.