Pancreas Transplantation

Definition

Pancreas transplantation is a surgical procedure in which a diseased pancreas is replaced with a healthy pancreas that has been obtained immediately after death from an immunologically compatible donor.

Purpose

The pancreas secretes insulin to regulate glucose (sugar) metabolism. Failure to regulate glucose levels leads to diabetes. Over one million patients in the United States have insulin dependent (type I) diabetes mellitus. Successful pancreas transplantation allows the body to make and secrete its own insulin, and establishes insulin independence for these patients.Pancreas transplantation is major surgery that requires suppression of the immune system to prevent the body from rejecting the transplanted pancreas. Immunosuppressive drugs have serious side effects. Because of these side effects, in 1996, 85% of pancreas transplants were performed simultaneously with kidney transplants, 10% after a kidney transplant, and only 5% were performed as a pancreas transplant alone.The rationale for this is that patients will already be receiving immunosuppressive treatments for the kidney transplant, so they might as well receive the benefit of a pancreas transplant as well. Patients considering pancreas transplantation alone must decide with their doctors whether life-long treatment with immunosuppressive drugs is preferable to life-long insulin dependence.The best candidates for pancreas transplantation are:

between the ages of 20-40
those who have extreme difficulty regulating their glucose levels
those who have few secondary complications of diabetes
those who are in good cardiovascular health.

Precautions

Many people with diabetes are not good candidates for a pancreas transplant. Others do not have tissue compatibility with the donor organ. People who are successfully controlling their diabetes with insulin injections are usually not considered for pancreas transplants.

National Transplant Waiting List By Organ Type (June 2000)
Organ Needed	Number Waiting
Kidney	48,349
Liver	15,987
Heart	4,139
Lung	3,695
Kidney-Pancreas	2,437
Pancreas	942
Heart-Lung	212
Intestine	137

Description

Once a donor pancreas is located, the patient is prepared for surgery. Since only about 1,000 pancreas transplants are performed each year in the United States, the operation usually occurs at a hospital where surgeons have special expertise in the procedure.The surgeon makes an incision under the ribs and locates the pancreas and duodenum. The pancreas and duodenum (part of the small intestine) are removed. The new pancreas and duodenum are then connected to the patient's blood vessels.Replacing the duodenum allows the pancreas to drain into the gastrointestinal system. The transplant can also be done creating a bladder drainage. Bladder drainage makes it easier to monitor organ rejection. Once the new pancreas is in place, the abdomen and skin are closed. This surgery is often done at the same time as kidney transplant surgery.

Preparation

After the patient and doctor have decided on a pancreas transplant, a complete immunological study is done to match the patient to a donor. All body functions are evaluated. The timing of surgery depends on the availability of a donated organ.

Aftercare

Patients receiving a pancreas transplantation are monitored closely for organ rejection, and all vital body functions are monitored also. The average hospital stay is three weeks. It takes about six months to recover from surgery. Patients will take immunosuppressive drugs for the rest of their lives.

Risks

Diabetes and poor kidney function greatly increase the risk of complications from anesthesia during surgery. Organ rejection, excessive bleeding, and infection are other major risks associated with this surgery.

Normal results

During a nine year period from 1987 to 1996, the patient survival rate for all types of pancreas transplants (with or without associated kidney transplant) was 92% after one year and 86% after three years. In a successful transplant, the pancreas begins producing insulin, bringing the regulation of glucose back under normal body control. Natural availability of insulin prevents the development of additional damage to the kidneys and blindness associated with diabetes. Many patients report an improved quality of life.

Key terms

Duodenum — The section of the small intestine immediately after the stomach.

Resources

Organizations

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. http://www.diabetes.org.

A procedure designed to halt the progression of severe complications of type 1 diabetes—e.g., diabetic neuropathy or end-stage renal disease—and achieve complete glycaemic control; pancreas transplantation requires harvesting of a large segment or the entire pancreas; donors are usually deceased. Patients with pancreatic cancer are not eligible for transplants, given their dismal prognosis due to almost certain cancer recurrence
Complications Post surgery complications include thrombosis, pancreatitis, infection, bleeding and rejection; the latter mandates immunosuppression for the rest of the patient’s life