A New Approach for Patients with Type 1 Diabetes and Kidney Failure: Simultaneous Cadaver Pancreas and Live Donor Kidney Transplantation (SPLK)
The University of Maryland offers numerous transplant options for patients with both kidney failure and diabetes. One approach is a combination of cadaver pancreas transplantation with living donor kidney transplantation (SPLK).
Traditionally, the only options for Type 1 diabetic patients with kidney failure have been simultaneous cadaver kidney and pancreas transplant (SPK) or living donor kidney transplant alone followed by a cadaver pancreas transplant at a later date (PAK). In the past, SPK transplantation has produced superior pancreas graft survival rates, because the pancreas comes from the same donor as the kidney and the kidney can be used to monitor for rejection. However, immunosuppression and the ability to monitor solitary pancreas transplant rejection have improved, resulting in better and better solitary pancreas graft survival rates.
Because SPK recipients miss out on the advantages of a living donor kidney transplant and PAK recipients undergo two operations to receive both a living donor kidney and a cadaver donor pancreas, we have combined the living donor kidney transplant and the cadaver pancreas transplant into a single operation (SPLK).
The pre-transplant evaluation for SPLK is essentially the same as for SPK and PAK transplantation. If a patient is interested in SPLK transplantation and has a willing kidney donor, the kidney donor is evaluated to determine that kidney donation is safe. Upon completion of their evaluation, the recipient and his or her living kidney donor await the availability of a cadaver pancreas donor. The wait for a cadaver donor for the pancreas has been as little as two days, and generally does not exceed 4 weeks.
When a cadaver donor for the pancreas becomes available, the recipient and the living donor for the kidney are brought into the hospital for the SPLK procedure. The recipient and living donor operations are started at the same time. While the kidney is being removed laparoscopically from the living donor, the pancreas transplant is performed in the recipient. The kidney transplant follows the pancreas transplant.
The average in hospital stay for SPLK patients is approximately 9 days. The kidney donor is able to go home after 2 days. Kidney and pancreas function is usually immediate, and patients no longer require insulin or dialysis soon after transplantation. We have found that the success rate of the kidney is >95% and the pancreas graft survival rate exceeds 85% at one year.
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