For some patients with serious illness and multiple organ failure, dual transplantation is a viable treatment that helps restore quality of life.
Kidney - Pancreas transplant
Simultaneous kidney pancreas transplant is an operation to place kidney and pancreas at the same time in a patient who has kidney failure and also suffers from diabetes, needing very high insulin dose to control sugars. It can be type 1 or burnt out type 2 diabetes. Type 1 diabetes is an autoimmune disease where patients own body attacks and destroys insulin producing beta cells located in the pancreas. It is typically seen in children and young adults. Type 2 diabetes is what we see commonly in adults. Over a period of time, these patients insulin producing cells stop making insulin or they are unable to produce enough to meet the body's demand.
Discovery of insulin converted lethal disease like diabetes into a chronic debilitating disease. Diabetes affects every system in the body. In the eyes it affects retina and is the leading cause of blindness. It affects the blood vessels supplying the heart and is common cause of heart attacks. It accelerates atherosclerosis which is a common cause of strokes/paralysis, heart failure and kidney failure. Uncontrolled sugars affect the nervous system also. Once the peripheral nervous system is affected, sensation in the hands and feet comes down. Continued injury is one of the leading causes of loss of limb.
Diabetic patients with kidney failure need kidney transplant to prolong their life. Steroids used as immunesupression will make treatment of diabetes difficult. Poorly controlled sugars will continue to affect the rest of the body including the transplanted kidney. Performing pancreas transplant at the same time will eliminate all these problems by optimally controlling sugars. It will not only protect the transplanted kidney form suture effects of diabetes but also reverse the effects of diabetes on other systems including peripheral neuropathy and thus protect the limbs.
Pancreas is most commonly transplanted along with kidney at the same time (SPK-simultaneous pancreas and kidney transplant)). However it can be transplanted after kidney transplantation(PAK-pancreas after kidney transplant). In rare situation, especially type 1 diabetics who have developed advanced neuropathy and are unable to appreciate low glucose levels (hypoglycemia unawareness) will benefit from pancreas alone transplant(PAT), even though they don't have kidney failure. They will be on unrestricted diet, free from frequent sugar checks and insulin injections.