Editorials

Combined kidney and pancreatic transplantation

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7188.886 (Published 03 April 1999) Cite this as: BMJ 1999;318:886

Ideal for patients with uncomplicated type 1 diabetes and chronic renal failure

  1. A Kumar, Senior registrar in renal medicine,
  2. C G Newstead, Consultant renal physician,
  3. J P A Lodge, Consultant transplant surgeon,
  4. A M Davison, Professor of renal medicine
  1. Departments of Renal Medicine and Organ Transplantation, St James's University Hospital, Leeds LS9 7TF

    Diabetes mellitus is the single most common cause of end stage renal failure in Western societies. Despite rigorous glycaemic control, dietary changes, exercise, and use of disease modifying drugs, some patients with diabetes, mostly but not exclusively those with type 1 disease, will develop renal failure requiring dialysis.1 In the first five years after transplantation, kidney graft survival is similar in diabetic and non-diabetic populations,2 but overall mortality in the diabetic group is three times that in non-diabetic transplant recipients.3Accelerated coronary atherosclerosis, sudden death related to autonomic neuropathy, and infection account for much of this excess mortality. Strict control of blood glucose with intensive insulin therapy reduces, but does not eliminate, these risks.1 In the United States simultaneous kidney and pancreas transplantation is now regarded by many clinicians as the treatment of choice for uraemic diabetic …

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