Kidney and pancreas transplantation in type 1 diabetes mellitus

Type 1 diabetes mellitus is characterized by autoimmune destruction of pancreatic beta cells, leading to a state of absolute insulin deficiency. Glycemic control via the use of exogenous insulin injections is often imperfect, resulting in multiple long-term complications, such as retinopathy, neuropathy, vasculopathy, and nephropathy. The Diabetes Control and Complications Trial has provided conclusive evidence that better glycemic control by intensive insulin treatment effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with insulin-dependent diabetes mellitus. At this moment, the only reliable option for achieving long-term insulin independence is whole-pancreas transplantation. The proposed benefits of pancreas transplantation are clear: improved quality of life, prevention of recurrent diabetic nephropathy, freedom from exogenous insulin with euglycemia and normalization of glycosylated hemoglobin, less stringent dietary restrictions, less frequent blood glucose monitoring, and stabilization of or improvement in secondary complications. The trade-offs to the patient are the operative risk, the need for chronic immunosuppression, and the inherent side effects of chronic immunosuppression.