Pancreas transplantation



Definition

Pancreas transplantation is a surgical procedure in which a diseased pancreas is replaced with a healthy pancreas that has been obtained from an immunologically compatible cadavear or living donor.


Purpose

The pancreas secretes insulin that regulates glucose (blood sugar) metabolism. Patients with type I diabetes have experienced partial or complete damage to the insulin-producing beta cells of the pancreas. Consequently, they are unable to generate sufficient insulin to control blood glucose levels. Long-term uncontrolled high blood glucose levels can cause damage to every system of the body, so type I patients must inject insulin to do the work of the beta cells. Pancreas transplantation allows the body to once again make and secrete its own insulin, and establishes insulin independence for these individuals.


Demographics

It is estimated that over one million people in the United States have type 1 diabetes mellitus (also called insulin-dependant diabetes or juvenile diabetes). Among these individuals, the best candidates for pancreas transplantation are typically:

A pancreas-only transplant is an uncommon procedure, with only 163 procedures occurring in the United States in 2001. More common is the combined kidney-pancreas transplant, which was performed on 885 patients the same year. An additional 305 patients received a PAK, or pancreas after kidney transplant, according to the United Network for Organ Sharing (UNOS).

Description

Once a donor pancreas is located and tissue typing deems it compatible, the patient is contacted and prepared for surgery. Blood tests, a chest x ray , and an electrocardiogram (ECG) are performed and an intravenous (IV) line is started for fluid and medication administration. Once the transplant procedure is ready to start, general anesthesia is administered.

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 duodenum, and the blood vessels are sutured together to restore blood flow to the new pancreas. The patient's original pancreas is left in place.

Replacing the duodenum allows the pancreas to drain into the gastrointestinal system. The transplant can also be done creating bladder drainage. Bladder drainage makes it easier to monitor organ rejection because pancreatic secretions can be measured in the patient's urine. Once the new pancreas is in place, the abdomen and skin are sutured closed. This surgery is often done at the same time as kidney transplant surgery .


Diagnosis/Preparation

After the patient and doctor have decided on a pancreas transplant, a complete immunological study is performed to match the patient to a donor. An extensive medical history and physical examination is performed, including radiological exams, blood and urine tests, and psychological evaluation. Once the patient is approved for transplant, he or she will be placed on the United Network for Organ Sharing (UNOS) Organ Center waiting list. The timing of surgery depends on the availability of a donated living or cadaver organ.


Aftercare

Patients receiving a pancreas transplantation are monitored closely for organ rejection. The average hospital stay is three weeks, and it takes about six months to recover from surgery. Patients will take immunosuppressant 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.

The reason simultaneous kidney-pancreas transplants and pancreas after kidney transplants are performed more frequently than pancreas only transplants is the relative risk of immunosuppressant drugs in people with diabetes. People with type I diabetes are already at risk for autoimmune problems, are more prone to infections, and have a complicated medical history that makes suppressing the immune system unadvisable.

On the other hand, diabetes is also the number one cause of chronic kidney failure, or end-stage renal disease (ESRD), which makes this group more likely to eventually require a kidney transplant for survival. In those patients with diabetes who will receive or are already receiving immunosuppressive treatment for a life-saving kidney transplant, a pancreas transplant can return their ability to self-produce insulin.

Patients with type I diabetes considering pancreas transplantation alone must weigh the risks and benefits of the procedure and decide with their doctors whether life-long treatment with immunosuppressive drugs is preferable to life-long insulin dependence.


Normal results

In a successful transplant, the pancreas begins producing insulin, bringing the regulation of glucose back under control. Natural availability of insulin prevents the development of additional complications associated with diabetes, including kidney damage, vision loss, and nerve damage. Many patients report an improved quality of life.


Morbidity and mortality rates

In their 2002 Annual Report, the Organ Procurement and Transplant Network (OPTN) reported that the patient survival rate for pancreas transplant alone was 98.6% after one year and 86% after three years. Survival rates for pancreas-kidney transplant recipients were 95.1% after one year and 89.2% after three years.


Alternatives

Innovations in islet cell transplants, a procedure that involves transplanting a culture of the insulin-producing islet cells of a healthy pancreas to a patient with type I diabetes, have increased the frequency of this procedure. The Edmonton Protocol, a type of islet cell transplant developed in 1999 by Dr. James Shapiro at the University of Alberta (Canada), uses a unique immunosuppresant drug regimen that has dramatically improved success rates of the islet transplant procedure. As of early 2003, the Edmonton Protocol was still considered investigational in the United States, and a number of clinical trials were ongoing.


Resources

periodicals

Norton, Patrice. "Pancreatic Human Islet Cells Offer Alternative to Pancreas Transplant." Family Practice News. 33 (January 2003): 14.

Reddy, K.S. et al. "Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure." American Journal of Kidney Disease 41 (February 2003): 464–70.

organizations

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

United Network for Organ Sharing (UNOS). 700 North 4th St., Richmond, VA 23219. (888) 894-6361. http://www.transplantliving.org .

Tish Davidson, A.M. Paula Anne Ford-Martin

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



A pancreas transplant is performed by a transplant surgeon in one of over 200 UNOS-approved hospitals nationwide. The patient must go through an evaluation procedure at his or her hospital of choice to get on the UNOS national waiting list and the UNOS Organ Center's UNet database.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Also read article about Pancreas Transplantation from Wikipedia

User Contributions:

1
laura-marie
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Jan 7, 2010 @ 3:15 pm
i have diabetes type 1 and just wondered how you can get on the waiting list ?
2
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Jun 13, 2010 @ 12:00 am
my husband has type 1 diabetes and i'd love to get him on the waiting list!!
3
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Sep 7, 2010 @ 10:10 am
I am a 62 year old female. In August, 2008 I had a total pancreatectomy and splenectomy due to IPMN. The biopsy revealed a 2cm malignancy in addition to the IPMN. Margins and lymph nodes were clean. I underwent chemotherapy (Gemzar) and have had no recurrence of the disease. I am now a very brittle diabetic (I'm on an insulin pump) and must take digestive enzymes whenever I eat. Would I be considered a candidate for a pancreas transplant?
4
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Jul 7, 2011 @ 9:09 am
Excellent article . I read about it in Gray's Anatomy . but i could not realize the process and accessories . But this article has helped me a lot .
5
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Sep 17, 2011 @ 4:04 am
I have had chronic familial pancreatitis since being diagnosed at age of 18 months. My children both have it also. We all are diabetic, Type I, it turned up at about age 15 for most of us. Have to use narcotic pain meds daily to control the daily pancreatitis pain, it is controlling our lives. We are all at risk of pancreas cancer. How can we get in touch with someone regarding the Islet Cell transplant or the Pancreas Transplant, no kidneys needed as of yet.
We are really in need, the pain is disabling and we just can't do this any longer. My oldest daughter has been hospitalized 10 times (for over a week at a time) in the past 10 months, she weighs 90 lbs at 5'4" and is so ill, we need some help. Our local doctors just don't know what to do long term.
6
maria
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May 18, 2012 @ 5:17 pm
where is the hospital location? how lang is the wait time? my husband has had diabeties scense 16 and hes 24 now is that possible for him to get a pancreas transplant?
7
Laura
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Jul 2, 2012 @ 9:09 am
I have type 1 diabetes AND chronic pancreatitis. My kidneys, even though I have had diabetes for many years (since my early 20s and I'm now in my early 40s), are in fine shape. However, the pancreatitis is worsening, with constant pain, nausea, vomiting, severe weight loss, huge fluctuation in blood sugars, inability to absorb nutrition and calories or even keep solid food down, elevated white cell, lipase and amylase counts and the insertion of a PICC line because my veins are no longer usable.

I know pancreas-only transplants are uncommon but I don't need a kidney. I'm so ready for this diseased and non-functioning organ to be removed from my body. I have already had my gallbladder and appendix taken out. This was done in an attempt to alleviate the attacks but it failed. I had gallstones. I don't drink alcohol at all. I'm so tired of this. I have being sick all the time. CP has cost me so much...my independence, my career...I could go on and on. I have to take oxycodone and phenergan on a daily basis. I would give anything to be able to live pain-free and resume some sort of productive life.

How far into this disease do I have to be before I can even be considered?
8
Erica
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Aug 13, 2012 @ 3:15 pm
To Jude:
I would consider taking your kids to the nearest childrens hospital. They have been wonderful to my son and have literally saved his life. Our regular doctors couldn't figure out what was wrong with him and he was losing weight at only a few months old. They thought we weren't feeding him properly but he ate all the time. We went to childrens and within a few visits he was diagnosed with a pancreas enzyme deficiency because his pancreas wasn't producing enzymes to break down his food properly. I honestly believe that without them his pediatrician would have not figured out what was going on and he would have basically withered away and died. We owe everything to childrens. I deffinitely think they could help your family. If a transplant is what they think your kids need then they would get them on the list with UNOS. Also they should be able to refer you to someone who can help you as well. I hope this helps. Erica
9
Susan
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Aug 22, 2012 @ 2:14 pm
Can a pancreas be transplanted with type one diabetes
10
Katherine
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Aug 29, 2012 @ 6:18 pm
My daughter has stricture of Ido following a botched gall bladder removal. She has had two ERCP's and is at risk for pancreatitis, diabetes and potentially pancreatic cancer. She is an otherwise healthy 35 year old mother of two small children. I want to know what tests can be done to see whether I am a good candidate for a donor for a liver or pancreatic transplant should one become necessary. We are both 0+ blood type.
11
david cavin
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Sep 1, 2012 @ 4:16 pm
i AM A TYPE 1 DIABETIC WITH ON GOING HYPO LOW BLOOD SUGAR UNAWARNESS MY dR IS SENDING ME TO usc for an evaluation for a pancreas tranplant do you have any sugestions Ive had diabetes now for close to 30yrs and now is more less controling my life in what I CAN AND CANT DO
12
Danielle
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Oct 5, 2012 @ 7:19 pm
Hi, I am a 23 yr old mother of 2 little girls who unfortunately have had to be away from me a big chunk of this past yr. A yr ago I start having a disabling pain and none of my doctors in montana could figure out after two months they hospitalized me for a month and found out I had pancreatitis the treated the pain and removed my gallbladder which was completely dead after that my main doctor wanted to send me to mayo clinic but the GI doc said I just needed to go home and the pain would go away. After that we decided to start taking action ourselves and after a trip to BAMC medical facility they did an ECRP and found they couldn't handle it but was sent to an amazing doctor who I would highly recommend him he has performed my last 4 procedures one of whic h was yesterday which the medicated the nerves to help the cp pain I have been to a high dose of Norcos and dilaudid for the past yr that never take the pain away so hoping this will help the pain till my next. Surgery which is supposed to either be a full pancreas removal or a pancreas transplant. You cand find most GI specialist who can handle this kind of pancreas problems at any Big Universities in big cities. A call is normally the best approach
as for either the Gi Department or Pancreas specialist. My doctor is in San Antonio. Tx his name is doctor Sandeep Patel at UT medical center. A group of caring and awesome doctors. He also trained under the doctor who came up with the ECRP so he is very experienced. I hope that helps someone.
13
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Nov 13, 2012 @ 2:14 pm
Im a Juvenal type 1, I got my diabetes at age 3 I am now 24. I am very healthy active try my best to be in control. My doctor and I was just talking about getting both transplants. I am going to Cleveland Ohio Clint Oct 16 2013. Im pretty excited about this but I am unsure. If I am going to just see if I am approved ? or Am I on a list Im a lil lost. I was told already I am a great canadent for both transplants.. I am praying & hoping I will be getting this.

Anyone can reach me on my email or face book look me up Charles Annarino Live Norwalk, Ohio age 24
14
Erin
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Jul 24, 2013 @ 7:19 pm
I just would like to say I am waiting on a pancreas transplant.. I always pray that God will make the person ready when it's time.. If it wasn't for God then I wouldn't be getting this opportunity. I wish you all the best and I will keep all of you in my prayers..
15
Renee
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Feb 8, 2015 @ 8:20 pm
My husband underwent a partial pancreatic removal (2/3)do to cancer. Would he be considered a candidate for this kind of surgery?
16
Esther
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Sep 19, 2015 @ 12:00 am
My son is type 1 diabetic for the past 3 yrs and now he is 9 years old. Can he undergo this surgery?

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