Abstract
Surgical treatments for Insulin Dependent Diabetes Mellitus (IDDM) complicated with Advanced Chronic Kidney Disease (CKD) have emerged with the hope of providing a better sustainable quality of life. This article aims to highlight the utility of kidney and pancreas transplant in the management of IDDM with renal failure. There are different surgical methodologies, of which Simultaneous Pancreas And Kidney Transplantation (SPK) has been the most promising; in terms of graft survival and decreasing the need for a second surgical intervention in terms of kidney transplant. However, long waiting lists to find matching donors and post-operative complications are the most challenging obstacles. All recipients shall be screened for anti-HLA antibodies, non-HLA antibodies and Coronary Heart Disease (CHD). The presence of CHD poses a mortality risk post-surgery. Recipient selection requires a meticulous insight based on the insulin requirements, with the fact that not all will achieve insulin independence. A donor’s risk factors must be estimated by the Pancreas Donor Risk Index (PDRI), the higher the score lower the chances of graft survival. Pancreatic graft failure has no unanimously agreed definition of rejection and is dependent on a variety of donor and recipient factors. Close follow up and a high index of suspicion for any unexplained signs or symptoms is required to detect early allograft rejection, and the consideration of other surgical and medical etiologies is also required. This mini review will discuss various options for the management of insulin dependent diabetics whose diabetes remain uncontrolled with maximal efforts and have developed advanced chronic kidney disease pending renal replacement.
Highlights
Background and Significance of the ProposalThere has been concern that transplant centers report graft failures at different clinical endpoints
The proposal’s purpose is to draft policy that assists transplant professionals to identify when pancreas allograft failure occurs and how to document the pancreas graft failure event. The proposal achieves this purpose by drafting policy for when a pancreas graft failed, updating Tiedi help documentation surrounding how to document pancreas graft failure, and updating the graft status section in the pediatric and adult pancreas and kidney-pancreas OPTN Recipient Registration and Recipient Follow-Up forms. (Unless otherwise noted, “OPTN pancreas forms” refers to the adult and pediatric pancreas and kidney-pancreas Transplant Recipient Registration Form (TRR) and Transplant Recipient Follow-up Form (TRF) throughout the proposal.)
Summary and Goals of the Proposal: The proposal’s purpose is to draft policy that help transplant professionals identify when pancreas allograft failure has occurred and how to document the pancreas graft failure event. The proposal achieves this purpose by drafting policy for when a pancreas graft failed, updating Tiedi help documentation surrounding how to document pancreas graft failure, and updating the graft status section in the OPTN pancreas forms
Summary
There is no nationally and consistently utilized definition for how to identify and document pancreas allograft failure. As part of this proposal, the Committee recommends to make the following updates to the OPTN pancreas forms: Remove “Partial Function” graft status category Updating the instructional language, in red font Create additional fields for specific data collection that will allow for future enhancement to the pancreas graft failure definition. The latter intended consequence will allow members to consistently and uniformly document pancreas graft failure Such a consistent and uniform practice will produce accurate and reliable nationally reported data that ideally will allow the Committee, and pancreas community, to make the definition more specific in the future as well as gain more insight as to when graft failure occurs. This separation was understood when examining graphical representations of the data
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