A pancreas transplant is surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to become independent of insulin injections.
Transplant - pancreas; Transplantation - pancreas
The healthy pancreas is obtained from a donor who has suffered brain-death, but remains on life-support. The donor pancreas must meet numerous criteria to make sure it is suitable.
A portion of the first part of the small intestine, called the duodenum, is transplanted along with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.
The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower portion of the patient's abdomen. Blood vessels from the new pancreas are attachmented to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder to drain pancreatic secretions.
The surgery for a pancreas transplant alone takes about 3 hours. However, the operation is usually done at the same time as a kidney transplant in diabetic patients 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, which is 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 doens't make enough, or sometimes any, insulin. This causes glucose to build up in the blood, resulting in high blood-sugar levels.
A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved, however, most people with type 1 diabetes do not have a pancreas transplant soon after they are diagnosed.
- Pancreas transplant is major surgery, and people with diabetes have a high-than-normal risk of heart disease and other complications.
- People who've had a pancreas transplant will need to take several medicines for the rest of their lives. These medicines have serious side effects.
Because of these risks, 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 may NOT be recommended for patients who also have:
- A history of cancer
- Infections such as hepatitis, which are considered to be active
- Lung disease
- Morbid obesity
- Other types of 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
The doctor may also recommend against pancreas transplant if there is concern that the patient will not be able to comply with the many follow-up visits, tests, and medications needed to keep the transplanted organ healthy.
The risks for any surgery are:
- Breathing problems
- Heart attack or stroke
- Infection or abscess
- Reactions to medications
- Scar formation
The risks for pancreas transplant include:
- Blood clots (deep venous thrombosis)
- Clotting (thrombosis) of the arteries or veins of the new pancreas
- Inflammation of the pancreas (pancreatitis)
- Leakage of fluid from the new pancrease where it attaches to the intestine or bladder
The body's immune system considers the transplanted organ foreign, and fights it accordingly. Thus, to prevent rejection, organ transplant patients must take drugs (such as cyclosporine and corticosteroids) that suppress (weaken) the body's immune response . This makes the person less able to fight various infections and can cause other medical problems.
Before the Procedure
Patients undergoing pancreas transplant have chronic kidney disease along with their diabetes. Because of this, a very thorough evaluation for heart disease is done beforehand.
See Kidney transplant.
After the Procedure
See Kidney transplant.
If the transplant is successful, you will no longer need to take insulin shots, test your blood-sugar daily, or follow a diabetic diet.
There is evidence to suggest that the complications of diabetes, such as diabetic retinopathy, may not worsen -- and may even improve -- after a pancreas-kidney transplant.
Drugs that prevent rejection of the donated pancreas and kidney must be taken for the rest of the patient's life.
See Kidney transplant.
Lipshutz GS, Wilkinson AH. Pancreas-kidney and pancreas transplantation for the treatment of diabetes mellitus. Endocrinol Metab Clin North Am. 2007;36(4).
Markmann FJ, Yeh H, Naji A, et al. Transplantation of abdominal organs. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 28.
James Lee, MD, Department of Surgery, Columbia Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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