# Simultaneous Pancreas and Kidney Transplantation in Patients With Type 2 Diabetes Mellitus

## TL;DR

This paper reviews the benefits and challenges of simultaneous pancreas and kidney transplants for patients with type 2 diabetes.

## Contribution

The paper emphasizes the need to evaluate whether SPK transplantation provides meaningful benefits specific to T2DM patients.

## Key findings

- SPK transplantation in T2DM patients shows comparable graft and patient survival to T1DM recipients.
- T2DM patients experience significantly improved graft survival with SPK compared to kidney transplants alone.
- Current literature focuses on comparing T1DM and T2DM outcomes, but the paper argues for a more personalized benefit-risk assessment for T2DM.

## Abstract

The prevalence of diabetes is increasing exponentially, accompanied by an increase in chronic complications, including nephropathy. Kidney transplantation may offer freedom from dialysis but adding a pancreas addresses the underlying disease. Type 2 diabetes mellitus (T2DM) is often described as a condition of insulin resistance and the concurrent beta-cell loss and dysfunction is potentially underestimated. The aim of this review was to provide a critical appraisal of simultaneous pancreas and kidney (SPK) transplantation in recipients with T2DM. The primary concern with SPK transplantation in this group is insulin resistance and the impact of obesity on outcomes. Multiple studies have shown comparable graft survival (GS), patient survival and complication rates when comparing T2DM and T1DM recipients. Furthermore, patients with T2DM had significantly improved GS with SPK when compared to kidney transplantation alone. Despite these findings, SPK transplantation is only selectively used in T2DM patients. Existing literature focuses on comparing transplant outcomes between patients with T1DM and T2DM. We believe the more relevant question is whether a patient with T2DM would derive a meaningful benefit from an SPK, and whether these benefits outweigh the risks, in the context of their other co-morbidities which are not completely similar to those associated with T1DM.