[Renal outcome after pancreas transplant in patients with unstable diabetes mellitus].

Combined kidney-pancreas transplant is currently the best treatment option for patients with type 1 diabetes associated with chronic renal failure. The favorable results of simultaneous pancreas-kidney transplants (SPK), introduced in the early 1990s, led to the introduction of the pancreas after kidney transplant (PAK) and the pancreas transplant alone (PTA), a good option for patients with uncontrolled diabetes. The superior results of SPK over PAK are partly related to better donor selection and partly to immunological factors. In conclusion, PAK transplant is a good preemptive choice for patients for whom a living kidney donor is available, so that long-term uremia while the patient is waiting for a cadaver pancreas graft can be avoided. Despite a high surgical complication rate in all types of pancreas transplant (SPK, PAK, PTA), patient survival is good and graft survival is improving year by year.