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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Simultaneous pancreas–kidney (SPK) transplantation is an established treatment for patients with end-stage kidneydisease (ESkD) secondary to diabetes mellitus. While historically reserved for type 1 diabetes (T1D), growing evidence supports its use in carefully selected insulin-dependent type 2 diabetes (T2D) patients, with outcomes comparable to those in T1D. Beyond metabolic benefits, SPK provides allocation advantages: candidates are often transplanted sooner than those listed for kidney-alone, and donor kidneys in SPK are typically of higher quality, originating from younger donors without significant medical co-morbidities. Registry analyses show that median waiting time for SPK is approximately 3 years, compared with 10 years for kidney-alone. Moreover, five-year kidney graft survival reaches 75–80% in SPK recipients versus 65–70% in kidney-alone recipients, and long-term patient survival is consistently higher in SPK, with ~85% at five years compared with 75–80% for kidney-alone. We report a case of patient with ESKD presumably secondary to insulin-dependent type 2 diabetes who was considered listed for SPK.
A 49-year-old man with long-standing T2D was evaluated at the pre-transplant clinic for candidacy for kidney transplantation. He had been diagnosed 22 years earlier, became insulin-dependent with a current insulin regimen of levemir Insulin 62 units every evening and aspart insulin 10-15 units (72-78 units of insulin per day); HbA1c 10.4%), and ultimately developed ESRD, requiring peritoneal dialysis for 3 years.
During pre-transplant workup, non-invasive stress testing was normal, but coronary angiography revealed double-vessel disease. He underwent successful coronary artery bypass grafting (CABG). Post-recovery, his functional status improved to NYHA class I, allowing reactivation on the transplant waitlist.
Pancreas transplant eligibility was confirmed (C-peptide 8.8ng/mL, BMI 26.6 kg/m², insulin dependence). HLA typing showed a total cPRA of 0%.
SPK was pursued because it offered:
● Metabolic benefit: restoration of β-cell function and long-term glycaemic stability.● Allocation benefit: shorter waiting time, with registry data showing SPK candidates transplanted 1–3 years after being on the SPK waiting list rather than 8 – 10 years if on kidney-alone waiting lis.● Donor quality advantage: higher likelihood of receiving a kidney from a younger donor with generally no medical comorbidity, predicting superior graft survival rates.
This case underscores the importance of comprehensive cardiovascular screening in transplant candidates. Despite a normal stress test, invasive angiography identified significant disease, requiring CABG before listing. Such optimisation is critical to ensure safety for complex procedures such as SPK.
It also illustrates the evolving role of SPK in insulin-dependent T2D. While some centers continue to limit pancreas transplantation to T1D, others extend eligibility to selected T2D patients with favourable metabolic and cardiovascular profiles. For this patient, the decision to pursue SPK was guided not only by the promise of insulin independence but also by evidence of earlier access and better long-term outcomes. National registry data demonstrate that SPK recipients have comparable one-year survival (~95%) to KT-alone recipients but achieve superior long-term outcomes, with 10-year patient survival of ~65–70% versus 55–60% for kidney-alone. These data reinforce the rationale for SPK as a strategy to reduce waiting time and improve kidney graft quality.
In regions where kidney-alone wait times may extend 8 - 10years, SPK offers a practical path to earlier transplantation, fewer years of dialysis exposure, and lower cardiovascular mortality. The combination of earlier access, higher-quality donor kidneys, and metabolic benefit helps explain why SPK recipients frequently achieve better renal and overall survival than those undergoing kidney-alone transplantation.
SPK transplantation in insulin-dependent T2D offers dual benefits: metabolic restoration and allocation advantage. By shortening waiting time, improving donor kidney quality, and supporting superior long-term survival, SPK may represent the preferred option in selected patients. Careful patient selection and awareness of regional practice patterns remain essential to maximising these benefits.
