Specific indications also exist for simultaneous pancreas-kidney transplant in T1D, which include confirmed DN with low/absent C-peptide on insulin treatment, a creatinine clearance of less than 15 mL/minute or the patient being on dialysis, presence of other micro and macrovascular complications of T1D such as cerebrovascular accidents or retinopathy, the ability to withstand immunosuppression and the physiological demands of surgery, and a history of compliance with medical advice and treatment [19]. The gene discussed is INS; the disease is type 1 diabetes mellitus.