Survival Advantage of Kidney-Pancreas vs. Kidney Alone Transplant in the Modern Era

AbstractPurpose of ReviewThere is a well-defined knowledge of relative benefits of pancreas transplants to patients with respect to specific diabetic complications; however, the degree of survival advantage of a simultaneous pancreas and kidney versus kidney transplant alone in the type I diabetes mellitus patient population remains controversial.Recent FindingsAt the crux of the issue, it remains that there is no randomized, controlled study on this topic. Moreover, the information that does exist is limited by inherent selection biases despite the most robust forms of statistical analysis in order to correct for the known issues within the data. Over time, studies have restricted group analyses to try to remove some of these biases.SummaryWhile there is an increase in morbidity and mortality early on with pancreas transplantation, most studies have suggested that there is probably a modestly improved long-term outcome in simultaneous kidney-pancreas over kidney transplant alone. In the absence of better data, candidate selection for kidney-pancreas transplantation should be guided towards individual needs and preferences, taking into consideration surgical risk, quality of life, potential for impact on secondary complication of diabetes, and desire to optimize outcomes.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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As many as 10% to 20% of patients undergoing kidney transplantation develop post-transplant diabetes mellitus, which is associated with increased mortality. Even borderline changes in glucose metabolism, so-called prediabetes, may involve a similar risk. A recent study by Porrini et  al. showed for the first time that such changes in glucose metabolism are in fact associated with future cardiovascular disease and death in kidney-transplanted patients. This commentary discusses the relevance and clinical implications of these new findings.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Commentary Source Type: research
Kidney transplantation is the treatment of choice for most patients with end-stage renal disease, and pancreas transplantation is the only treatment for type 1 diabetes mellitus that can induce insulin-independent normoglycemia.
Source: Medscape Today Headlines - Category: Consumer Health News Tags: Resource Center Source Type: news
In conclusion, our findings link the calcification of the vascular tissue with the expression of FGF23 in the vessels and with the elevation of circulating levels this hormone. Permanently Boosting Levels of Natural Killer Cells in Mice to Increase Cancer Resistance Researchers here demonstrate a very interesting approach to immunotherapy: they introduce engineered stem cells in mice that will give rise to additional natural killer T cells, boosting the capability of the ...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
This article's objective is to describe CKD's integration into Cuba's National Noncommunicable Diseases (NCD) Program and the main outcomes regarding the burden of CKD and associated risk factors in Cuba. Cuba offers free health services to all its citizens on the basis of a strong primary healthcare system focused on prevention. The CKD National Program is coordinated by the Institute of Nephrology and includes the National Program for Prevention of CKD, which addresses all levels of prevention. The following indicators for renal replacement treatment are from 2016. The incidence of new patients on dialysis was 109 per mi...
Source: Clinical Nephrology - Category: Urology & Nephrology Authors: Tags: Clin Nephrol Source Type: research
In conclusion, our study suggests that a large percentage did not have nephrology care before initiating dialysis. The ones who were seen by nephrology before dialysis were significantly more likely to initiate dialysis using an AVF. A national focus on improving nephrology referral in advanced CKD may allow better utilization of AVF as the method of access at dialysis initiation. PMID: 31696849 [PubMed - in process]
Source: Saudi Journal of Kidney Diseases and Transplantation - Category: Urology & Nephrology Authors: Tags: Saudi J Kidney Dis Transpl Source Type: research
The objective of the present study was to analyze the impact of income, education, and ethnicity in hypertension, diabetes mellitus (DM), and chronic kidney disease (CKD) in the world, through the narrative review of the literature and analyzing the social indicators HDI and IHDI of the countries analyzed. After analyzing 161 studies from 96 countries, we identified that income, education, and color impact on the prevalence, incidence, diagnosis, treatment, progression, and mortality of hypertension, DM, and CKD in both low- and middle-income countries' development, as well as high and very high human development. The HDI ...
Source: Saudi Journal of Kidney Diseases and Transplantation - Category: Urology & Nephrology Authors: Tags: Saudi J Kidney Dis Transpl Source Type: research
In this study, we estimated the levels of Mg, which is an important trace element and pro-oxidant marker, and then evaluated the association between serum Mg and pro-oxidants in patients with DN. In the present study, 200 patients were enrolled and were divided into two groups. The control and DN groups consisted of 100 healthy individuals and 100 patients with DN, respectively. Serum Mg, total anti-oxidant capacity (TAC), and superoxide dismutase (SOD) levels were estimated using the Calmagite, Koracevic, and Marklund and Marklund methods, respectively. Glutathione (GSH) and malondialdehyde (MDA) levels were estimated usi...
Source: Saudi Journal of Kidney Diseases and Transplantation - Category: Urology & Nephrology Authors: Tags: Saudi J Kidney Dis Transpl Source Type: research
Prediabetes and post-transplant diabetes mellitus affect about 20-30% of renal transplant patients. The latter is a risk factor for cardiovascular disease. However, no clear evidence linking prediabetes and cardiovascular disease is available. To study this we analyzed the impact of prediabetes on cardiovascular disease in 603 renal transplant patients followed with repeated oral glucose tests for up to five years and a long term survival evaluation. Prediabetes and post-transplant diabetes mellitus were defined at 12 months after transplantation to avoid their high reversibility rate before this period.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Clinical Investigation Source Type: research
Maximizing anti-HBs seroresponsiveness in kidney transplant waitlist patients: 
A tertiary-center perspective
. Clin Nephrol. 2019 Jul 26;: Authors: Udomkarnjananun S, Townamchai N, Wattanatorn S, On-Yim L, Vanichanan J, Jutivorakool K, Avihingsanon Y, Praditpornsilpa K, Eiam-Ong S, Leelahavanichkul A Abstract BACKGROUND: Patients on dialysis are at risk of hepatitis B virus (HBV) infection, and antibodies against the hepatitis B surface antigen (anti-HBs) ≥ 10 IU/L are required. However, a high percentages of HBV vaccine nonresponders have been reported. We aimed to determine the optimal ...
Source: Clinical Nephrology - Category: Urology & Nephrology Authors: Tags: Clin Nephrol Source Type: research
Purpose of review To summarize the existing body of literature regarding quality of life after pancreas transplantation, discuss the limitations of existing studies and make an argument for the need for future investigation on this important topic using standard verifiable instruments and utility measurements. Recent findings Reinvigorating support for pancreas transplantation as a life-extending and quality-of-life-enhancing treatment for complicated diabetes mellitus remains a work in progress. Over the past two decades, improvements in surgical management, donor selection, recipient selection and immunosuppression ...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: KIDNEY PANCREAS: Edited by Matthew Cooper Source Type: research
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