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Pancreas transplants can be beneficial to people with type 1 diabetes, but there are some drawbacks. Fat Camera/Getty Images
  • Researchers say pancreas transplants can help people with type 1 diabetes with insulin levels and glucose monitoring.
  • However, they note that the number of pancreas transplants has declined in recent years.
  • Experts say there are drawbacks to the transplants, including the need for a person to take immunosuppressants for the rest of their life.

Up to 90% of people who received a pancreas transplant enjoy freedom from insulin therapy and the need for close glucose monitoring.

That’s according to a paper published today in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Pancreas transplant surgery is when a person with diabetes receives a donor pancreas without removing the original pancreas. A successful pancreas transplant is when the patient no longer needs to take insulin and their blood sugar is well controlled.

However, the pancreas recipient will need to take immunosuppressants for the rest of their life to prevent their immune system from rejecting the donor pancreas.

Although a pancreas transplant can achieve better glucose control than other diabetes treatments, the number of transplants has declined in recent years, according to the paper.

The authors list several possible reasons:

  • Lack of a primary referral source
  • Lack of general acceptance by the diabetes care community
  • The absence of consensus criteria
  • Issues with access, education, and resources within the transplant community

In addition, experts say a transplant may not be as good as a person may hope.

“The authors of the study present pancreas transplant as a ‘cure’ for diabetes but then talk about a five-year graft survival. Suppose the average patient is transplanted around age 40, we would then need a graft that can last at least 30 to 40 years. The figures show a median graft survival of around eight years,” said Dr. Kathleen Wyne, an endocrinologist at The Ohio State University Wexner Medical Center.

“Additionally, the toxicity of the immunosuppression outweighs the benefit,” Wyne told Healthline. “The transplanted pancreas does not always work well, so the patient might not be completely insulin-free. However, I do believe that the combined kidney/pancreas transplant should be considered for all patients with type 1 diabetes with an indication for a kidney transplant.”

People with type 1 diabetes who have kidney disease or other life-threatening consequences from uncontrolled diabetes are the most common recipients of pancreas transplants, according to the Transplant Surgery Department at the University of California San Francisco.

The transplant can elimiinate the need for insulin injections and restrictive diets. It can reduce or eliminate low blood sugar and prevent damage to other organs because of diabetes.

The cause of type 1 diabetes is the body’s inability to produce enough insulin. The new pancreas produces insulin but does not help the body use insulin. Those with type 2 diabetes are usually not offered pancreas transplants because this type of diabetes is a result of the body’s inability to use insulin effectively or produce enough insulin to manage blood sugar.

A pancreas transplant could be a viable treatment for people:

  • Whose type 1 diabetes is not controlled, even with treatment
  • Who have frequent severe insulin reactions
  • Who have poor blood sugar control
  • Have hypoglycemia unawareness, meaning they lose awareness of their body’s signs of low blood sugar
  • Have severe kidney damage

To stay healthy, people with type 1 diabetes must adhere to caring for themselves daily.

According to the Centers for Disease Control and Prevention, everyday tasks include:

  • Controlling blood pressure
  • Controlling cholesterol
  • Physical activity
  • Healthy eating

After a pancreas transplant, there is a trade-off. While physical activity and healthy eating are still important, blood sugar checks and insulin are replaced by immunosuppressants.

“I would not consider the risk as a minor one. If a pancreas transplant can provide the benefit of [being] insulin-free, elimination of hypoglycemia, and cessation of the need for glucose monitoring for a long time, a pancreas transplant might be worth consideration, says Shumei Meng, MBBS, Ph.D., an endocrinologist at The Ohio State University Wexner Medical Center and clinical associate professor of internal medicine at The Ohio State University College of Medicine.

“But if the pancreas transplant only lasts a few years then the price of going through a big surgery and the long-term commitment to immunosuppressant seems not a small trade-off,” Meng told Healthline.

“If a patient’s diabetes is well controlled with the assistance of a glucose monitoring system with or without an automated insulin pump,” continued Meng, “the risk to proceed with a surgery and to be committed with lifelong immunosuppressant makes the pancreas transplant a less appealing option.”