Although often performed as a last resort, the pancreas transplant has become a key treatment for people with type 1 diabetes. Pancreas transplants are also sometimes carried out in people who require insulin therapy and have type 2 diabetes. However, this is much less common.
The first human pancreas transplant was completed in 1966. The United Network for Organ Sharing (UNOS) reports that more than 32,000 transplants have been performed in the United States between January 1988 and April 2018.
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. This is a task that a transplant candidate’s existing pancreas can no longer perform properly.
A pancreas transplant is mainly done for people with diabetes. It typically won’t be used to treat people with other conditions. It’s rarely done to treat certain cancers.
There are several types of pancreas transplants. Some people may have a pancreas transplant alone (PTA). People with diabetic nephropathy — damage to the kidneys from diabetes — can receive a donor pancreas and kidney. This procedure is called simultaneous pancreas-kidney (SPK) transplant.
Similar procedures include pancreas after kidney (PAK) and kidney after pancreas (KAP) transplants.
A pancreas donor is usually someone who’s declared brain-dead 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 a recipient’s immune system reacts adversely to the donated organ.
Occasionally, pancreatic donors are living. This may happen, for example, if the transplant recipient can find a donor who’s a close relative, such as an identical twin. A living donor gives part of their pancreas, not the whole organ.
There are more than 2,500 people on the waiting list for some type of pancreas transplant in the United States, notes UNOS.
According to Johns Hopkins Medicine, the average person will wait one to two years to have an SPK performed. People who receive other types of transplants, such as a PTA or PAK, will typically spend more than two years on the waiting list.
You’ll receive a medical evaluation at a transplant center before any sort of organ transplant. This will involve multiple tests to determine your overall health, including a physical exam. A healthcare professional at the transplant center will also review your medical history.
Before you receive a pancreas transplant, specific tests you may undergo include:
- blood tests, such as blood typing or an HIV test
- a chest X-ray
- kidney function tests
- neuropsychological exams
- studies to check your heart function, such as an echocardiogram or electrocardiogram (EKG)
This evaluation process will take one to two months. The goal is to determine whether you’re a good candidate for surgery and whether you’ll be able to handle the post-transplant drug regimen.
If it’s determined that a transplant will be appropriate for you, then you’ll be placed on the transplant center’s waiting list.
Keep in mind different transplant centers will likely have different preoperative protocols. These will also vary further depending on the type of donor and overall health of the recipient.
If the donor is deceased, your surgeon will remove their pancreas and an attached section of their small intestine. If the donor is living, your surgeon will usually take a portion of the body and tail of their pancreas.
A PTA procedure takes around two to four hours. This procedure is carried out under general anesthesia, so the transplant recipient is fully unconscious throughout to not feel any pain.
Your surgeon makes a cut down the center of your abdomen and places the donor tissue in your lower abdomen. They’ll then attach the new section of the donor small intestine containing the pancreas (from a deceased donor) to your small intestine or the donor pancreas (from a living donor) to your urinary bladder and attach the pancreas to blood vessels. The recipient’s existing pancreas usually remains in the body.
Surgery takes longer if a kidney is also transplanted via an SPK procedure. Your surgeon will attach the donor kidney’s ureter to the bladder and blood vessels. If possible, they’ll usually leave the existing kidney in place.
Post-transplant, recipients stay in the intensive care unit (ICU) for the first few days to allow close monitoring for any complications. After this, they often move to a transplant recovery unit within the hospital for further recuperation.
A pancreas transplant involves many types of medications. A recipient’s drug therapy will require extensive monitoring, especially since they’ll take a number of these drugs every day to prevent rejection.
As with any organ transplant, a pancreas transplant carries the possibility of rejection. It also carries the risk of failure of the pancreas itself. The risk in this particular procedure is relatively low, thanks to advancements in surgical and immunosuppressant medication therapy. There’s also a risk of death associated with any surgery.
The Mayo Clinic notes the five-year survival rate of a pancreases transplant is about 91 percent. According to a 2015 review, the half-life (how long it lasts) of a pancreas transplant in SPK transplantation is at least 14 years. Researchers note that an excellent long-term survival of the recipient and the pancreas graft in this type of transplantation can be achieved by people who have type 2 diabetes and are of advanced age.
Doctors have to weigh the long-term benefits and risks of transplant against the complications and potential for death associated with diabetes.
The procedure itself carries a number of risks, including bleeding, blood clots, and infection. There’s also an added risk of hyperglycemia (high blood sugar) occurring during and right after the transplant.
The drugs given after the transplant can also cause serious side effects. Transplant recipients have to take many of these drugs long term to prevent rejection. Side effects of these drugs include:
Since the first pancreas transplant, there have been many advances in the procedure. These advancements include better selection of organ donors as well as improvements in immunosuppressant therapy to prevent tissue rejection.
If your doctor determines a pancreas transplant is an appropriate option for you, the process will be a complex one. But when a pancreas transplant is successful, recipients will see an improvement in their quality of life.
Talk to your doctor to determine whether a pancreas transplant is right for you.
People considering an organ transplant can also request an information kit and other free materials from the UNOS.