A pancreas transplant is a surgery where a pancreas from a donor body is given to someone who needs a new pancreas. This surgery is most often performed for patients with type 1 diabetes whose pancreas and kidneys have both failed. In many cases, a pancreas transplant is done at the same time as a kidney transplant—this is called a kidney-pancreas transplant.
The pancreas produces a chemical called insulin that signals glucose, or blood sugar, to move from the bloodstream into the cells in the tissues of the body. There, the glucose is used as an energy source. In people with type 1 diabetes, the pancreas either does not produce enough insulin, or it does not produce insulin at all. This results in high levels of glucose in the blood, which causes several complications, including:
- heart disease
- kidney damage
- nerve damage
- limb amputation
To control the disease, diabetics must inject insulin on a daily basis.
Because of the risks involved with such a major surgery, a pancreas transplant is usually only recommended for diabetics who are also experiencing kidney failure. In this case, the surgery’s benefits far outweigh the risks and lifestyle changes that will accompany the surgery.
Getting a new pancreas will allow most recipients to live a more normal lifestyle, free from the need to take insulin and check blood sugar daily. However, individuals who undergo this procedure will need to take medications for the rest of their lives to stop the patient’s body from rejecting the new organ. Unfortunately, these medications will worsen the patient’s immune system.
To perform this major surgery, you will be placed under general anesthesia. This means you will be asleep. The surgeon will make an incision in the center of your abdomen and will put the donor pancreas, along with a portion of the small intestine, alongside your pancreas. The donor organ will be connected to your intestines and to blood vessels.
If you are also receiving a new kidney at the same time, it will be placed in with your nonfunctioning kidney and then connected to the necessary blood vessels.
Your old, nonfunctioning pancreas will be left in because it still plays a role in your digestive system, even though it no longer produces insulin. If your kidney that does not work is not causing any problems, such as pain or infection, it will be left in place as well.
Pancreas transplant surgery alone takes about three hours. With a kidney transplant, the surgery will take a few additional hours (Mayo, 2011).
The benefit of a pancreas transplant is that it can restore your body’s ability to make and use insulin. This means you will no longer have to test your blood sugar daily or give yourself insulin injections to stabilize your blood sugar levels. Also, with a functioning pancreas, you may not get the serious complications that result from having type 1 diabetes, which include nerve damage, blindness, and stroke. You may also find that any complications already present will not get any worse.
A pancreas transplant is a major surgery, and there are several risks involved. With any major surgery, you will be placed under anesthesia (“put to sleep”). The anesthetic may cause an allergic reaction or breathing problems in some individuals. You may also lose a lot of blood, have a heart attack or stroke, or develop an infection. There are also risks that are specific to the transplant, including:
- blood clots in the legs
- clots in the blood vessels of the new pancreas
- pancreatitis (inflammation of the pancreas)
- fluid leakage from the pancreas attachment to the intestines or bladder
- rejection of the donor organ
- failure of the donor organ
Before you can schedule a transplant surgery, you must be carefully evaluated by your doctors and surgeons. In most cases, you must have kidney failure in addition to type 1 diabetes to be eligible for this procedure. If you do not have kidney failure, you may be considered a candidate, but only if you have severe complications from your diabetes or if other treatments have not been able to control the disease.
The transplant team may order several tests to assess the functioning of your organs and your eligibility for the procedure. You may need to have blood work done to see how well your organs are working. You may then need to have other tests to make sure there is no reason the surgery would be riskier for you than for other candidates. For instance, the transplant team will want to check your urine and blood to find out if you have any infections or diseases that will make surgery risky.
If you are considered a good candidate for a pancreas transplant, you will then have to wait for donor organs to be available. You will be placed on a national list for transplants. According to the United Network for Organ Sharing (UNOS), the average wait time for a pancreas is between 300 to 400 days and 300 days for a combined pancreas and kidney (National Kidney Foundation, 2012).
After a transplant, you will need to remain in intensive care for at least a few days. Doctors will need to monitor you to be sure that the new pancreas is working and that there are no major complications. Once you are considered stable enough to leave intensive care, you will still need to stay in the hospital for another week to recover.
As you recover at home, you will need checkups regularly for several weeks to be sure everything is functioning properly. You will also need to take medications that suppress your immune system. When you get a new organ, your immune system sees the organ as a foreign object and attacks it. These drugs prevent this response. You will continue to take these medications for the rest of your life.
The best results for a transplant are when the pancreas is replaced at the same time as a kidney. After one year, 87 percent of transplant patients have a functioning pancreas. After five years, 72 percent still have a working pancreas (Mayo, 2011). If your new pancreas fails, you can resume insulin therapy or be considered for a second transplant.