Pancreas Transplant

Pancreas transplant is a surgical procedure wherein the impaired pancreas of a patient is replaced by a healthy one. Usually, a deceased person is chosen as a donor for the pancreas transplant.

Pancreas, which is located in the lower part of the abdomen, plays the crucial role in regulating the blood glucose level by secreting a hormone called insulin. Insulin is responsible for the absorption of blood sugar by the cells.

Pancreas transplant is mostly performed in cases of type-1 diabetes but can also be done for treating some cases of type-2 diabetes and very rarely in cases of pancreatic cancer or bile duct disorders also.

Although pancreas transplant is an effective alternative, there are certain side effects, therefore; this procedure is only prescribed if the patient is suffering from serious health issues.

Here are the most common reasons to undergo a pancreas transplant. The pancreas transplantation is mainly considered a solution for type 1 diabetes but it is not the standard treatment procedure for type 1 diabetes.

The patient is advised to take anti-rejection medicines post-transplantation, which may cause some other side-effects but in cases where other treatments are not effective pancreas transplant is a life-saving procedure.

In type 1 diabetes, where the patient’s inability to produce the hormone insulin make it necessary for him/her to get the pancreas replaced as this condition cannot be controlled by standard treatments.

If the patient is suffering from serious damage to the kidney due to type 1 diabetes then the pancreas transplant is combined with the kidney transplant or can also be  done the post-kidney transplant.

This is basically done in order to implant healthy kidney and pancreas to the patient which will result in less diabetes-related kidney issues in the future.

This procedure of pancreas transplant has certain risks and complications that may include:

• Formation of blood clots
• Bleeding
• Increased risk of infections
• Excess sugar in the blood (hyperglycemia)
• Urinary problems like leakage or the infection of urinary tract.
• Side-effects of anti-rejection medication like Bone thinning, High cholesterol, High blood pressure, Sensitivity in the skin, Gain in weight, Acne, or Excess hair growth.

In preparing for your pancreas transplant, you must follow your doctor’s orders. If the doctor advises the patient for the pancreas transplant, then the patient should visit transplantation center but the choice of the center depends on upon the patient.

Before choosing a center, the patient should consider the following points:

• The number of transplantation carried in the center and their success rate.
• The donor and the recipient survival rate.
• Compare transplant center statistics with the help of the database that is maintained by the Scientific Registry of Transplant Recipients
• Other points that should be considered can include the support groups of the center, travel arrangements, a local housing facility for the patient to take rest so as to recover.

The eligibility criteria of the patient for the pancreas transplant that are led by the center authorities.

Once the patient fulfills the eligibility criteria the team may consider the following points:

• Health status of the patient to tolerate the post-transplant medication.
• Any kind of medical condition that is likely to interrupt the success of the transplant.
• Whether the patient is ready to take the medications and the advice as directed by the doctor.
• If the patient needs his/her kidney to be transplanted along with the pancreas transplant then the team can perform both simultaneously or the pancreas transplant can be performed after few days of the kidney transplant. The gap between the transplants may depend on upon the severity of the damage to the kidney, availability of the donor and the preference of the patient.
• The patients who have to undergo transplantation are registered on the national list of people awaiting a transplant. The time period that the patient needs to wait for the surgery depends on the blood group of the patient and the time that is used for the search for the suitable donor whose blood group and the tissue type should match the patient.
• The patient should make sure to take the medicines in a proper manner as prescribed by the doctor.
• The patient should also follow a healthy diet and exercise guidelines and should stay in touch with his/her healthcare team.

Read on to learn more about what to expect before, during, and after your pancreas transplant. The surgeon will perform the transplantation after giving an anesthetic medication as a gas or a liquid medication into a vein.

The team will check the blood pressure, heart rate and blood oxygen before and throughout the procedure. Once the patient is in an unconscious state, a cut is made in the center of the patient’s abdomen to place the healthy pancreas along with a small portion of the donor’s small intestine.

The donor’s intestine is connected to the patient’s intestine or the bladder. Then the transplanted pancreas is connected to the blood vessels that supply blood to the legs. The patient’s own pancreas is kept in place to aid digestion.

In case the patient is also undergoing a kidney transplant, the blood vessels of the healthy kidney will be attached to the blood vessels in the lower part of patient’s abdomen and the ureter is attached to the recipient’s bladder.

Once the transplantation is complete the patient will stay in ICU for few days and will be monitored for any kind of complications. Usually, the implanted pancreas-kidney will start working immediately after the transplantation but in some cases, they may start working after few days.

Once the patient is stable he/she is taken to the transplant recovery area for recuperation. The patients have to take medications for the rest of their life. Drugs like immuno-suppressants are advised in order to protect the immune system from attacking your new pancreas. Other drugs may help in reducing the other complications.

Understanding the results of your pancreas transplant will be made possible by your doctor. The new pancreas will start making insulin, therefore, the patient will not require taking insulin therapy for the treatment of diabetes.

There are conditions where despite having similarities between the donor and recipient, the immune will try to reject the new organ. Therefore, immunosuppressant drugs are given to avoid rejection.

The doctor will also prescribe the patients with antibacterial, antiviral and antifungal medication to avoid other infections that are the result of using immunosuppressants. According to the Organ Procurement and Transplantation Network:

In the case of simultaneous pancreas-kidney transplant, the survival rate is 85% and the transplanted pancreas-kidney will work normally after 1 year and after 5 years the functionality is decreased to 73%.

In pancreas-after-kidney transplant, the survival rate is 82% and the transplanted pancreas functions properly after one year and the rate is decreased to 65% after five years.

For the pancreas-only transplant, the survival rate is 76% and the transplanted pancreas functions properly after one year but after 5 years the functionality rate is reduced to 53%.

There still exists the confusion that why the survival rate is more for the patient who have undergone kidney and pancreas at the same time.

Some research and studies indicate that the possible reason for this could be the difficulty in monitoring and detect the rejection of the pancreas when transplanted alone. If the transplanted pancreas fails to produce insulin, the patient will again need insulin therapy.