Kidney Transplantation in the Diabetic Patient

Diabetes mellitus is a worldwide epidemic and an uncontrolled global disease that continues to affect an increasing number of patients and health care expenditures across all countries. Not only is diabetes mellitus a disease of rapidly increasing prevalence but also the main cause of chronic kidney disease (CKD) and end stage renal disease (ESRD). The development of CKD and ESRD in diabetic patients is testament to insufficient metabolic control. Although a successful kidney transplant can render the uremic diabetic patient dialysis-free for a long time, it does not provide a cure to the underlying disease which can even be worsened as a result of diabetogenic and nephrotoxic immunosuppressants that are necessary to prevent the occurrence of graft rejection. Despite great advances in modern insulin administration, new delivery devices and pumps including the bionic pancreas, new medications and promising research approaches, normoglycemia cannot be achieved with conventional methods, no matter how sophisticated. But even if glucose control is significantly improved by various exogenous insulin regimens, near-normoglycemia does not prevent the development of the secondary complications of diabetes mellitus. Currently, only a successful pancreas transplant achieves short- and long-term normoglycemia at the expense of major surgery and the need for posttransplant immunosuppression.