Choices in kidney transplantation in type 1 diabetes: Are there skeletal benefits of the endocrine pancreas?

Traditionally, recipients of a simultaneous pancreas-kidney (SPK) versus kidney transplant alone (KTA) were thought to have higher fracture risk. Using a large US registry, Nikkel et al observed lower rates of fracture hospitalization among patients with type 1 diabetes after SPK compared to KTA, particularly among men. It is not known whether the apparent benefit of SPK is due to improved bone strength or fewer falls, but these findings may influence transplant decision making. Long term patient and kidney allograft survival after kidney alone or simultaneous pancreas-kidney transplant in patients with type 1 diabetes are similar.1 The choice between these strategies is often individualized and may be based on their expected impact on morbidity, in conjunction with other preference-based factors, such as wait time and the availability of living donors. Fractures are common after transplantation2 and result in a substantial burden of disability.3 This may be particularly relevant to patients with type 1 diabetes because of further elevation in fracture risk as a result of diabetes.4 Despite this, few studies have specifically evaluated the risk of fracture in patients with type 1 diabetes after kidne