Which of the following statement(s) is/are true concerning associated renal and pancreatic transplantation?

a. The most important advantage is the use of renal function as an early indicator of pancreatic graft rejection

b. After renal transplant, there is no additional risk associated with immunosuppression

c. A major disadvantage of simultaneous renal/pancreatic transplant is the potential adverse effect on renal allograft as the result of a pancreatic complication

d. A diabetic with a renal transplant continues to be at risk for diabetic nephropathy

In the patient with a functional renal transplant, because of the need for long-term immunosuppression, the demonstration of a prior allograft acceptance and a continued risk for recurrent diabetic nephropathy are compelling reasons to offer pancreatic transplantation. The advantages to simultaneous renal-pancreatic transplantation compared to a sequential procedure (renal followed by pancreatic) include 1) the recipient’s need to accept only one set of donor antigens; 2) the ability to monitor rejection of the pancreas by identifying the well-recognized signs of renal allograft rejection; 3) the immunosuppressive effect of uremia; 4) transportation in patients who have not been maintained on chronic immunosuppression; and 5) a single albeit longer anesthetic exposure. Of these advantages, the most important is the use of renal function as an early indicator of pancreatic graft rejection. The disadvantages of simultaneous renalpancreatic transplantation include extensive surgery in a uremic diabetic patient and the potential adverse effect on renal allograft function as the result of a pancreatic complication. Ideally, pancreatic transplantation should be performed in patients who do not yet have, but are designed to develop, secondary complications to diabetes that are more serious than the potential side-effects of immunosuppression. In recipients of a pancreas after a kidney, the only risks of pancreatic transplant are related to the surgery since immunosuppression is already obligatory.