Transplant - pancreas; Transplantation - pancreas
A pancreas transplant is surgery to implant a healthy pancreas from a donor into a person with diabetes. Pancreas transplants give the person a chance to stop taking insulin injections.
The healthy pancreas is taken from a donor who is brain dead, but is still on life support. The donor pancreas must be carefully matched to the person who is receiving it. The healthy pancreas is transported in a cooled solution that preserves the organ for up to about 20 hours.
The person's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the person's abdomen. Blood vessels from the new pancreas are attached to the person's blood vessels. The donor duodenum (first part of the small intestine right after the stomach) is attached to the person's intestine or bladder.
The surgery for a pancreas transplant takes about 3 hours. This operation is usually done at the same time as a kidney transplant in diabetic people with kidney disease. The combined operation takes about 6 hours.
Why the Procedure is Performed
The pancreas makes a substance called insulin. Insulin moves glucose, a sugar, from the blood into the muscles, fat, and liver cells, where it can be used as fuel.
In people with type 1 diabetes, the pancreas does not make enough, or sometimes any, insulin. This causes glucose to build up in the blood, leading to a high level of sugar in the blood. High blood sugar over a long time can cause many complications, including:
- Disease of the arteries
- Heart disease
- Kidney damage
- Nerve damage
A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved with surgery, most people with type 1 diabetes do not have a pancreas transplant just after they are diagnosed.
Pancreas transplant is rarely done alone. It is almost always done when someone with type 1 diabetes also needs a kidney transplant.
Pancreas transplant surgery is not usually done in people who also have:
- A history of cancer
- Infections such as hepatitis, which are considered to be active
- Lung disease
- Other blood vessel diseases of the neck and leg
- Severe heart disease (such as heart failure, poorly controlled angina, or severe coronary artery disease)
- Smoking, alcohol or drug abuse, or other lifestyle habits that can damage the new organ
Pancreas transplant is also not recommended if the person will not be able to keep up with the many follow-up visits, tests, and medicines needed to keep the transplanted organ healthy.
Risks of anesthesia and surgery in general include:
- Reactions to medicines
- Breathing problems
Risks of pancreas transplant include:
- Clotting (thrombosis) of the arteries or veins of the new pancreas
- Development of certain cancers after a few years
- Inflammation of the pancreas (pancreatitis)
- Leakage of fluid from the new pancreas where it attaches to the intestine or bladder
- Rejection of the new pancreas
Before the Procedure
Once your doctor refers you to a transplant center, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for pancreas and kidney transplant. You will have several visits over several weeks or even months. You will need to have blood drawn and x-rays taken.
Tests done before the procedure include:
- Tissue and blood typing to help make sure your body will not reject the donated organs
- Blood tests or skin tests to check for infections
- Heart tests such as an ECG, echocardiogram, or cardiac catheterization
- Tests to look for early cancer
You will also want to consider one or more transplant centers to determine which is best for you:
- Ask the center how many transplants they perform every year and what their survival rates are. Compare these numbers to those of other transplant centers.
- Ask about support groups they have available and what type of travel and housing arrangements they offer.
If the transplant team believes you are a good candidate for a pancreas and kidney transplant, you will be put on a national waiting list. Your place on a waiting list is based on a number of factors. These factors include the type of kidney problems you have and the likelihood that a transplant will be successful.
While you are waiting for a pancreas and kidney, follow these steps:
- Follow any diet your transplant team recommends.
- DO NOT drink alcohol.
- DO NOT smoke.
- Keep your weight in the range that has been recommended. Follow any recommended exercise program.
- Take all medicines as they have been prescribed for you. Report changes in your medicines and any new or worsening medical problems to the transplant team.
- Follow up with your regular doctor and transplant team on any appointments that have been made.
- Make sure the transplant team has the correct phone numbers so they can contact you immediately when a pancreas and kidney become available. Make sure, no matter where you are going, that you can be contacted quickly and easily.
- Have everything ready before going to the hospital.
After the Procedure
You will need to stay in the hospital for about 3 to 7 days or longer. After you go home, you will need close follow-up by a doctor and regular blood tests for 1 to 2 months or longer.
Your transplant team may ask you to stay close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests and imaging tests for many years.
If the transplant is successful, you will no longer need to take insulin shots, test your blood-sugar daily, or follow a diabetes diet.
There is evidence that the complications of diabetes, such as diabetic retinopathy, may not get worse and may even improve after a pancreas-kidney transplant.
More than 95% of people survive the first year after a pancreas transplant. Organ rejection occurs in about 1% of people each year.
You must take medicines that prevent rejection of the donated pancreas and kidney for the rest of your life.
Becker Y, Witkowski P. Kidney and pancreas transplantation. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 26.
Gruessner AC, Gruessner RWG. Pancreas and kidney transplantation for diabetic nephropathy. In: Morris PJ, Knechtle SJ, eds. Kidney Transplantation: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2014:chap 36.