The outcome of simultaneous pancreas-kidney (SPK)
transplantation in
type 1 diabetes has dramatically improved in recent years because of optimized surgical techniques and new immunosuppressive
drug regimens. Normoglycemia is followed by stabilization or even regression of diabetic lesions, i.e., of heart and kidneys. However, these effects are only visible after more than five yr of normoglycemia (achieved by a functioning allograft). This is also a likely explanation for the conflicting results of studies that investigated patient or kidney graft survival in SPK
transplantation compared to
kidney transplantation alone. Most studies had too short follow-up periods, i.e., less than five yr, to compare effectively different transplant strategies in patients with
type 1 diabetes and therefore failed to discover a survival benefit in favor of simultaneously transplanted patients. Recent data now indicate that, with a longer follow-up, there is an increasing survival benefit for simultaneously transplanted patients compared to patients who received a
single kidney transplant. This is paralleled by the comparison of simultaneously transplanted patients to patients who received a
single kidney transplant from a living donor. A survival benefit for the combined procedure was here visible after 10 yr of follow-up. We give a short overview on SPK
transplantation, with a focus on the effects of this procedure on
diabetic complications as well as patient and kidney graft survival.