Pancreatic Transplantation as Treatment for IDDM: Proposed Candidate Criteria Before End-Stage Diabetic Nephropathy

Abstract

Most candidates for pancreatic transplantation have end-stage diabetic nephropathy (ESDN) and receive a pancreas transplant either sequential to or simultaneous with a renal transplant. Because ESDN is often associated with severe irreversible neurovascular complications, the selection of these candidates may defeat the intent of pancreatic transplantation, i.e., the reversal, stabilization, or retardation of neurovascular complications. Also, advanced neurovascular complications in these candidates may result in serious morbidity and mortality after pancreatic transplantation. Our multidisciplinary Pancreas Transplant Evaluation Committee has developed tentative candidate criteria for insulin-dependent diabetic patients before ESDN. With the proposed criteria, candidates are selected who have predictors of future morbidity and mortality but who do not yet demonstrate irreversible neurovascular complications and an inexorable general course of deterioration. As pancreatic transplantation becomes more successful, candidate criteria must be continually reassessed to better identify those who may obtain maximal benefit.