Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review.
Kukla A., Ventura-Aguiar P., Cooper M., de Koning EJP., Goodman DJ., Johnson PR., Han DJ., Mandelbrot DA., Pavlakis M., Saudek F., Vantyghem M-C., Augustine T., Rickels MR.
Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity and better patient and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of β-cell replacement therapy: pancreas or islet transplantation. International variation related to national regulatory policies exists in offering one or both options to suitable candidates and is further affected by pancreas/islet allocation policies and transplant waiting list dynamics. The selection of appropriate candidates depends on patient age, coexistent morbidities, the timing of referral to the transplant center (predialysis versus on dialysis) and availability of living kidney donors. Therefore, early referral (estimated glomerular filtration rate