Figure 1220

Diabetes and hyperparathyroidism. Patients with difficult to control diabetes may be candidates for simultaneous kidney-pancreas transplantation. However, patients with diabetes who have a living donor are generally better off undergoing transplantation with the living donor kidney alone. Patients with symptomatic hyperparathyroidism or uncontrolled hypercalcemia should be considered for parathy-roidectomy before transplantation. Medications that interfere with the metabolism of immunosuppressive agents such as cyclosporine should be substituted with appropriate alternatives, if possible, before transplantation. (From Kasiske and coworkers [1]; with permission.)

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