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  • May be performed in diabetic patients with end-stage renal disease either as simultaneous pancreas-kidney (SPK) transplantation, or as pancreas-after-kidney (PAK) transplantation.
    • Pancreas transplantation has minimal impact on immunosuppression.
  • Nonuremic patients with type 1 diabetes usually receive pancreas transplantation alone (PTA).
    • Risk of immunosuppression is added to the surgical risk.

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Absolute

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  • Untreated or recent malignancy.
  • Active or chronic infection.
  • Inability to comply with postoperative immunosuppression and follow-up.

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Relative

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  • Advanced extrarenal complications of diabetes (coronary artery disease).
  • Evidence of insulin resistance (type 2 diabetes, insulin requirements > 1 unit/kg, BMI > 30).

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  • For both donor and recipient procedures:
    • The patient should be supine.
    • The abdomen is entered through a midline incision.

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  • Nothing by mouth until return of bowel function.
  • Exogenous insulin should not be necessary.
    • Exceptions: cases of delayed graft function or use of high-dose steroids for treatment of rejection.

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  • Enteric drainage is associated with leak, peritonitis, and abscess.
  • Bladder drainage is associated with urethritis or cystitis, and dehydration.

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