title: Simultaneous pancreas and kidney transplantation: current trends and future directions.
abstract: OBJECTIVE
  Important trends are being observed in pancreas transplantation in the USA. We will describe recent trends in simultaneous pancreas kidney (SPK) transplantation related to immunosuppression, treatment of rejection, and transplantation for patients of advanced age and C-peptide positive diabetes.
  
  
  RESULTS
  Rates of pancreas transplantation have declined, despite improved pancreatic graft outcomes. Regarding immunosuppression, trends in SPK transplantation include T-cell depletion induction therapy, waning mammalian target of rapamycin inhibitor use and steroid use in greater than 50% of pancreas transplant recipients with few patients undergoing late steroid weaning. Rejection of the pancreas may be discordant with the kidney after SPK and there is a greater appreciation of antibody-mediated rejection of the pancreas allograft. De-novo donor-specific antibody without graft dysfunction remains an active area of study, and the treatment for this condition is unclear. SPKs are being performed with greater frequency in type 2 diabetes mellitus patients and in patients of advanced age, with exemplary results.
  
  
  CONCLUSIONS
  The current state of the art in SPK transplantation is yielding superb and improving results.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin -Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA *Joseph R. Scalea and Robert R. Redfield contributed equally to the writing of this article.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Scalea
authors.forename: Jon S
authors.initials: JS
authors.lastname: Odorico
mesh_terms: D000818:Animals; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000639:trends*; D016035:Pancreas Transplantation / Q000639:trends*