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Simultaneous pancreas-kidney (SPK) and pancreas living-donor kidney (SPLK) transplantation at the University of Maryland.

The evolution of enteric and portal venous drainage, better immunosuppression, and better patient care has elevated pancreas transplantation with dramatically improved results. At our center, long-term graft survival and rejection has significantly improved with portal venous drainage, which has become our gold standard. This improvement is exemplified by the excellent one-year patient and graft survival rates for SPLK transplants. SPLK has proven to be an ideal approach in uremic Type 1 diabetic patients with living donors and should become the procedure of choice for that population. Moreover, the improved monitoring of rejection has allowed a similar success of pancreas transplantation alone in non-uremic patients with brittle diabetes. The treatment of diabetes mellitus has room for great improvement, however, and there is no question that islet transplantation, xenotransplantation, and the pursuit of immunologic tolerance will play an extremely important role in that endeavor.