Diabetic nephropathy surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Surgery in patients with diabetic nephropathy involves kidney and/or pancreatic transplantation.

Surgery

Surgery in patients with diabetic nephropathy involves kidney and/or pancreatic transplantation. Kidney transplant is an alternative to dialysis in patients with ESRD. The choice of kidney and pancreas transplantation is usually reserved for patients with type I diabetes mellitus, as well as selected patients with type II diabetes mellitus.

Kidney-Pancreas Transplantation

The kidney–pancreas transplantation can be done as a simultaneous pancreas–kidney (SPK) transplant, a sequential pancreas after kidney (PAK) transplant or a pancreas transplant alone (PTA).^[1]
The simultaneous kidney–pancreas transplantation is associated with improved mortality rate and quality of life.
The improved mortality rate is due to kidney transplantation, even without the pancreatic transplant.
On the other hand, the improved quality of life has much to do with the pancreatic transplantation, due to no longer needing to monitor blood glucose, giving insulin or suffering from the adverse effects of an abnormal blood glucose levels (hypo- or hyperglycemia).^[2]^[3]^[4]^[5]

Kidney Transplantation

Kidney transplantation is the gold standard of treatment in the case of ESRD due to diabetes mellitus or other causes.
It is considered superior to dialysis in patients who are fit for surgery, due to the better quality of life it offers.^[6]
The main challenges facing kidney transplantation are graft survival and the use of long-term immunosuppressive drugs.^[7]

References

↑ Venstrom JM, McBride MA, Rother KI, Hirshberg B, Orchard TJ, Harlan DM (2003). “Survival after pancreas transplantation in patients with diabetes and preserved kidney function”. JAMA. 290 (21): 2817–23. doi:10.1001/jama.290.21.2817. PMID 14657065.
↑ Nathan DM, Fogel H, Norman D, Russell PS, Tolkoff-Rubin N, Delmonico FL, Auchincloss H, Camuso J, Cosimi AB (1991). “Long-term metabolic and quality of life results with pancreatic/renal transplantation in insulin-dependent diabetes mellitus”. Transplantation. 52 (1): 85–91. PMID 1858159.
↑ Becker BN, Odorico JS, Becker YT, Groshek M, Werwinski C, Pirsch JD, Sollinger HW (2001). “Simultaneous pancreas-kidney and pancreas transplantation”. J. Am. Soc. Nephrol. 12 (11): 2517–27. PMID 11675431.
↑ Kendall DM, Rooney DP, Smets YF, Salazar Bolding L, Robertson RP (1997). “Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy”. Diabetes. 46 (2): 249–57. PMID 9000702.
↑ Cottrell DA, Henry ML, O’Dorisio TM, Tesi RJ, Ferguson RM, Osei K (1991). “Hypoglycemia after successful pancreas transplantation in type I diabetic patients”. Diabetes Care. 14 (11): 1111–3. PMID 1797502.
↑ Stites E, Wiseman AC (2016). “Multiorgan transplantation”. Transplant Rev (Orlando). 30 (4): 253–60. doi:10.1016/j.trre.2016.04.002. PMID 27515042.
↑ Dousdampanis P, Trigka K, Mouzaki A (2016). “Tregs and kidney: From diabetic nephropathy to renal transplantation”. World J Transplant. 6 (3): 556–63. doi:10.5500/wjt.v6.i3.556. PMC 5036125. PMID 27683634.

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[pmid14657065-1] Venstrom JM, McBride MA, Rother KI, Hirshberg B, Orchard TJ, Harlan DM (2003). “Survival after pancreas transplantation in patients with diabetes and preserved kidney function”. JAMA. 290 (21): 2817–23. doi:10.1001/jama.290.21.2817. PMID 14657065.

[pmid1858159-2] Nathan DM, Fogel H, Norman D, Russell PS, Tolkoff-Rubin N, Delmonico FL, Auchincloss H, Camuso J, Cosimi AB (1991). “Long-term metabolic and quality of life results with pancreatic/renal transplantation in insulin-dependent diabetes mellitus”. Transplantation. 52 (1): 85–91. PMID 1858159.

[pmid11675431-3] Becker BN, Odorico JS, Becker YT, Groshek M, Werwinski C, Pirsch JD, Sollinger HW (2001). “Simultaneous pancreas-kidney and pancreas transplantation”. J. Am. Soc. Nephrol. 12 (11): 2517–27. PMID 11675431.

[pmid9000702-4] Kendall DM, Rooney DP, Smets YF, Salazar Bolding L, Robertson RP (1997). “Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy”. Diabetes. 46 (2): 249–57. PMID 9000702.

[pmid1797502-5] Cottrell DA, Henry ML, O’Dorisio TM, Tesi RJ, Ferguson RM, Osei K (1991). “Hypoglycemia after successful pancreas transplantation in type I diabetic patients”. Diabetes Care. 14 (11): 1111–3. PMID 1797502.

[pmid27515042-6] Stites E, Wiseman AC (2016). “Multiorgan transplantation”. Transplant Rev (Orlando). 30 (4): 253–60. doi:10.1016/j.trre.2016.04.002. PMID 27515042.

[pmid27683634-7] Dousdampanis P, Trigka K, Mouzaki A (2016). “Tregs and kidney: From diabetic nephropathy to renal transplantation”. World J Transplant. 6 (3): 556–63. doi:10.5500/wjt.v6.i3.556. PMC 5036125. PMID 27683634.

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