Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up Featured Article: Roger Lehmann, Jessica Graziano, Jens Brockmann, Thomas Pfammatter, Philipp Kron, Olivier de Rougemont, Thomas Mueller, Richard A. Zuellig, Giatgen A. Spinas, and Philipp A. Gerber Diabetes Care Volume 38: May, 2015

STUDY OBJECTIVE In end-stage renal disease, combined transplantation of a kidney together with a pancreas or isolated pancreatic islets improves glycemic control This study compares long-term outcome in regard to metabolic control and surgical complication rate, as well as function of the transplanted kidney Lehmann R. et al. Diabetes Care 2015;38:

STUDY DESIGN AND METHODS Consecutive patients received either a pancreas or islet transplant simultaneously with or after kidney transplantation: Simultaneous pancreas-kidney (SPK) Pancreas-after-kidney (PAK) Simultaneous islet-kidney (SIK)/islet-after-kidney (IAK) Lehmann R. et al. Diabetes Care 2015;38:

RESULTS 94 SPK/PAK transplantation patients were compared with 38 patients SIK/IAK transplantation patients for up to 13 years HbA1c levels declined from 7.8 ± 1.3 to 5.9 ± 1.1% and from 8.0 ± 1.3 to 6.5 ± 1.1%, respectively, in the SPK/PAK and SIK/IAK groups Levels remained stable during follow-up, despite a 90% reduction in the rate of severe hypoglycemia 5-year insulin independence rate was higher in the SPK/PAK group, as was the rate of relaparotomy after transplantation No difference occurred in the rate of kidney function decline Lehmann R. et al. Diabetes Care 2015;38:

CONCLUSIONS SPK/PAK and SIK/IAK transplantation resulted in a sustained improvement in glycemic control SIK/IAK group had a slightly higher glycated hemoglobin level Although insulin independence is more common in whole- organ pancreas recipients, islet transplantation has a lower surgical complication rate and no difference in kidney function decline Lehmann R. et al. Diabetes Care 2015;38: