Pancreas Transplantation

For patients with type 1 diabetes, a pancreas transplant can mean a life free from testing blood sugar, taking insulin, and the constant threat of dangerous fluctuations in blood glucose. A relatively uncommon procedure, pancreatic transplant is reserved primarily for type 1 diabetics who cannot effectively control their diabetes through diet or insulin injections, or who have end stage kidney failure and require a kidney transplant. Patients with kidney failure may receive pancreatic transplantation, either simultaneously with the kidney or in a separate procedure following kidney transplantation.

Additionally, pancreas transplantation is beneficial for diabetics who no longer develop symptoms when their blood sugar gets too low. Under some circumstances pancreas transplantations may be utilized for type 2 diabetics as well.

Types of pancreas transplant surgery:

  1. Patients may receive both a pancreas and a kidney at the same time from the same deceased donor.
  2. Patients may first receive a kidney from a living donor, and then later have a pancreas transplant from a deceased donor.
  3. The small percentage of patients with hypoglycemic awareness who do not have any significant kidney injury may receive a pancreas transplant alone.

In the first option, if the patient’s body rejects the kidney, it will reject the pancreas at the same time. That is a small advantage because otherwise it’s hard to detect pancreas rejection, which is almost always treatable. This occurs in about 10 percent of patients.

The second option is preferable because kidney transplant results are significantly better when from a living donor. Also, it can take years to get a kidney from a deceased donor, while waiting times for a pancreas alone is much shorter.

Dr. Lloyd E. Ratner, Director of the NewYork-Presbyterian/Columbia Renal and Pancreatic Transplant Program, explains more about pancreas transplants in this video:

Who Might Need a Transplant?

Most candidates for a pancreas transplant fall into three main categories, all of which are related to diabetes, according to Lloyd E. Ratner, MD, Director of the NewYork-Presbyterian/Columbia Renal and Pancreatic Transplant Program.

Most candidates have type 1 diabetes and kidney failure. They either need or already have had a kidney transplant. Other patients do not have kidney failure but are “brittle” type 1 diabetics; despite vigilance in taking their insulin and how they eat, their blood sugar still is very difficult to control, and they have serious complications associated with their diabetes. People in the third group can’t tell when they have low blood sugar and are in danger of losing consciousness or dying. This condition is called hypoglycemic unawareness.

Benefits of Pancreas Transplantation

The three important benefits of replacing a pancreas are:

  1. A huge improvement in a patient’s lifestyle. Instead of spending up to three hours a day in controlling blood sugar, they will enjoy stable levels without insulin or any special diet.
  2. By significantly improving or ending the patient’s diabetes, pancreas transplantation will protect a patient’s new kidney from being injured.
  3. It often slows down or even reverses secondary complications from diabetes: eye disease, vascular disease, gastrointestinal problems, and neuropathy.

Risks of Pancreas Transplantation

A certain amount of risk comes with a pancreas transplant, as in any surgery. If the pancreas is injured by mishandling or low blood pressure, it can release digestive enzymes, cause inflammation of the surrounding tissue, and make a patient feel fairly sick. Also, the blood supply to the pancreas is more tenuous than to other organs, so there is a greater chance of clotting.

But these risks decrease to a minimal level as long as surgeons are very careful about caring for the pancreas before and during surgery. The net result for almost all candidates is that a pancreas transplant’s benefits greatly exceed its risks.

The Operation and Beyond

Pancreas transplant surgery takes between four to six hours. A lot of that time is spent carefully preparing the pancreas. The pancreas is placed in the right side of the abdomen through a vertical incision. Another advantage to having already had a kidney transplant is a shorter, smoother operation.

Most patients go to the Intensive Care Unit for one to two days for very close monitoring, then transfer to a regular hospital floor for seven to 10 days. Follow up is similar to that after a kidney transplant: frequent at first, and eventually laboratory work once a month and office visits three to four times a year.