Evidence Review
Copyright ©The Author(s) 2023.
World J Transplant. Sep 18, 2023; 13(5): 208-220
Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.208
Table 1 Current indications and contraindications for simultaneous pancreas-kidney in type 1 diabetes mellitus[11,12,15]
Current indications for SPK in T1DM
Confirmed diabetic nephropathy with low or absent C-peptide, on insulin treatment
Creatinine clearance < 15 mL/min or on dialysis
Presence of other microvascular or macrovascular complications of T1DM
Ability to withstand immunosuppression and surgery
History of compliance with medical advice and treatment
Absolute contraindications for SPK in T1DM
Significant cardiovascular disease with severe or non-correctable coronary artery disease
Cardiac ejection fraction < 50%
Recent myocardial infarction
Non-curable malignancy except localized skin cancer
Active sepsis
Active peptic ulcer disease
Severe mental health conditions that can lead to non-compliance
Inability to survive surgery or immunosuppression due to significant comorbidity
Relative contraindications for SPK in T1DM
Cerebrovascular event with long-standing impairment
Human immunodeficiency virus, hepatitis B and C virus infections
BMI > 30 kg/m2
Age > 60 yrs
Extensive vascular, aortic, and renal artery disease (making surgery high-risk)
Excessive need for insulin > 1.5 U/kg/d
Continuous use of alcohol, smoking, and other drugs