What is the optimal approach for the end-stage diabetic nephropathy patient considering simultaneous pancreas-kidney transplantation?
This case-based discussion regards two very different patients with end-stage diabetic nephropathy (ESDN) who are considering transplantation. What is the best approach for each individual: pancreas-kidney transplant or kidney transplant alone? Suppose a live kidney donor is available? What are the risks and benefits of each approach? In the candidate evaluation process, medical issues, such as uncorrectable coronary artery disease, are investigated and may preclude transplantation altogether or dictate the optimal approach. Similarly, a careful psychosocial profile is important to tailor the approach to the patient. The multidisciplinary transplant team has an obligation to provide informed consent, foster realistic expectations, and advise the candidate based on collective expertise. Ultimately, the decision as to the best course-pancreas-kidney, kidney transplant alone, or no transplantation-is the result of a collaborative effort between the patient and the transplant team.
Dafoe
D C
DC
Department of Surgery, Stanford University School of Medicine, CA, USA.
Scandling
J D
JD
Waskerwitz
J A
JA
Beinin
M L
ML
D000328:Adult; D001291:Attitude of Health Personnel; D003928:Diabetic Nephropathies / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009730:Nursing Assessment; D016035:Pancreas Transplantation / Q000379:methods*; D010551:Personality