Although often a last resort, the pancreas transplant has become a key treatment for patients with diabetes, especially those who suffer from Type 1 diabetes. Pancreas transplants are also sometimes carried out in Type 2 diabetes patients who are insulin dependent.
The first human pancreas transplant was completed in 1966; in 2009, more than 23,000 patients in the United States received a pancreas transplant.
The aim of a transplant is to restore normal blood glucose levels to the body. The transplanted pancreas is able to produce insulin to manage blood glucose levels — a task a transplant candidate’s existing pancreas can no longer perform properly.
There are several types of pancreas transplants. Some people may have a pancreas transplant alone (PTA). Patients suffering from diabetic nephropathy (damage to the kidneys) will often receive a pancreas and kidney in a procedure called simultaneous pancreas–kidney (SPK) transplant. Similar procedures include pancreas after kidney (PAK) and kidney after pancreas (KAP) transplants.
How It Works
A pancreas donor is usually someone who has suffered brain death but remains on a life support machine. This donor has to meet common transplant criteria including being a certain age and otherwise healthy. The donor’s pancreas also has to match immunologically with the recipient’s body. This is important to help reduce rejection risk. Rejection occurs when the body’s immune system reacts to the transplanted organ.
Unfortunately, there is a long national waiting list for a pancreas transplant; according to the United Network for Organ Sharing, the average wait for a pancreas is 300 to 400 days, and there are over 2,200 people on the wait list.
Occasionally, pancreatic donors are living. This may happen, for example, if the patient can find a donor who is a close relative such as an identical twin. A living donor gives part of his or her pancreas, not the whole organ.
Whether a donor is living or nonliving, during the donor procedure, the surgeon will remove the pancreas and an attached section of the small intestine.
A PTA procedure takes around three hours. This procedure is carried out under general anesthesia, meaning that the patient is unconscious throughout. The surgeon makes a cut down the center of the abdomen and places the new pancreas and small intestine section in the lower abdomen. The surgeon will then attach the new section of intestine to the small intestine or bladder and attach the pancreas to blood vessels. The patient’s existing pancreas remains in the body.
Surgery takes longer if a kidney is also transplanted via an SPK procedure. The surgeon will attach the new kidney to the bladder and blood vessels and, if possible, will leave the existing kidney in place.
Post-transplant patients stay in the intensive care unit for the first few days to allow close monitoring for any complications. After this, they often move to a transplant center—a dedicated center for organ transplant patients—for further recuperation. A pancreas transplant involves many medications, and patients’ drug therapy will require extensive monitoring, especially as they will remain on a number of these drugs for life.
Are There Any Risks?
As with any organ transplant, a pancreas transplant carries the possibility of rejection as well as failure of the pancreas itself. The risk in this particular procedure is low: More than 95 percent of patients will survive the first year after a pancreas transplant. Pancreas transplants now have a half-life of around 12 years. This means that half of the patients with pancreas transplants will have functioning organs 12 years after transplant.
Physicians have to weigh the long-term benefits and risks of transplant against the potential mortality and complications associated with diabetes.
The procedure itself carries a number of risks including bleeding, blood clots, and infection. There is also an added risk of hyperglycemia (high level of blood glucose) occurring during the transplant.
The drugs given after the transplant can also cause serious side effects, and patients will have to take many of these drugs for life. Side effects include high cholesterol and blood pressure, thinning of the bones, excessive hair growth, and weight gain.
Other Disorders Pancreas Transplants Treat
A pancreas transplant is only a suitable treatment for diabetics, usually those with Type 1 diabetes.
What the Expert Says
Since the first pancreas transplant there have been many advances in the procedure, including better selection of organ donors. According to a 2010 article in Gut and Liver, patient outcomes are now much better, and most patients will see an improvement in their quality of life.
However, it has been suggested (in Current Opinion in Organ Transplantation, for example) that there are still improvements to be made with pancreas transplants, especially around patient survival rates.
The University of Maryland Medical Center offers online video interviews with leading physicians as well as patients who have had a pancreas transplant: http://www.umm.edu/media/channel/transplantation.htm
The United Network for Organ Sharing has produced a handbook for all patients considering an organ transplant: http://www.unos.org/docs/WEPNTK.pdf