Medical and urological complications of pancreas and kidney/pancreas transplantation

Abstract Simultaneous pancreas and kidney transplantation (SPKTx) is a well-established therapeutic option for selected patients with endstage renal disease (ESRD) secondary to type I diabetes mellitus. Refinements in surgical techniques and important advances in immunosuppressive therapy have allowed patient and graft survival to reach levels comparable to those seen in kidney alone (KA) transplantation. Nevertheless, morbidity in pancreas transplants remains high, in part due to special problems that are inherent to pancreas transplantation. Variations in surgical techniques may result in different types and incidence of both surgical and medical complications. Urinary diversion of exocrine secretions of pancreas allografts may result in unique acid–base and electrolyte disorders, whereas systemic venous drainage of the endocrine system may lead to peripheral hyperinsulinaemia and peripheral insulin resistance.