Definition and Overview

The pancreas is an abdominal organ responsible for producing digestive juices and certain hormones, including insulin. Thus, it plays a key role in breaking down food and converting them into energy.

Patients with diabetes have a malfunctioning pancreas that is unable to produce a sufficient supply of insulin. This imbalance causes a string of symptoms that characterise type 1 diabetes. A pancreas transplant procedure can relieve these symptoms by replacing the malfunctioning pancreas with a healthy one.

Who Should Undergo and Expected Results

A pancreas transplant is sometimes recommended as a treatment for diabetes since patients who suffer from type 1 diabetes are unable to produce their own supply of insulin. By replacing the pancreas with a healthy one that can produce insulin, the symptoms of diabetes are also relieved.

However, not all diabetic patients are good candidates for a pancreas transplant. Doctors first weigh the potential risks and benefits of the procedure for each individual patient prior to making their recommendations. A pancreas transplant for diabetes is only recommended if:

  • The patient also have a severe kidney disease, in which case they might need a kidney and pancreas transplant

  • The patient has episodes of severe hypoglycemia (too low blood sugar levels) despite ongoing insulin treatment

  • The insulin injections are not producing the desired effects

Even patients who can potentially benefit from the procedure are not automatically considered as good candidates. They still have to undergo a thorough medical assessment and evaluation to see whether they are healthy enough to undergo surgery. The evaluation will look at factors such as blood pressure, heart rate, and the overall health of the patient’s heart. For the assessment, patients undergo the following procedures:

  • Standard urine and blood tests

  • X-rays

  • Duplex scan

  • Echocardiogram

  • Electrocardiogram

  • Coronary angiography

Another important factor to consider prior to undergoing the surgery is the pancreas transplant cost as well as the cost of immunosuppressant medications.

Meanwhile, an organ transplant surgery is not recommended for:

  • Patients with coronary heart disease

  • Patients who recently suffered a heart attack

  • Patients with incurable cancer

  • Obese patients

  • Patients who drink alcohol excessively

  • Patients who abuse drugs

  • Patients with a mental health or behavioral problem that renders them unable to take the necessary medications after the procedure

For those who do undergo surgery, the pancreas transplant success rate is quite high. Up to 97% of patients live at least a year following the procedure, and up to 90% live at least five years. The majority of them also live decades following the procedure.

Kidney and pancreas transplant life expectancy rates are higher than those of patients who undergo a pancreas transplant alone. Around 85% of all donor pancreas still function very well after a year, and 75% still work as normal five years after a kidney and pancreas transplant. On the other hand, patients who undergo a pancreas transplant alone have a shorter life expectancy. Only 65% of donor pancreas are still properly functioning after a year, and this percentage falls to just 45% five years after the procedure.

How is the Procedure Performed?

A pancreas transplant is performed under general anaesthetic, which means that patients are asleep throughout the procedure and will therefore not feel any pain. The procedure needs to be done as soon as a donor pancreas becomes available. This, however, also means that patients could be on the waiting list for the procedure for a long time.

The surgery involves making an incision along the stomach area, allowing the surgeon to place the donor pancreas in the abdomen and attach it to nearby blood vessels as well as to the bowel. The donor pancreas will start working right away and will immediately produce insulin. The old pancreas is left in place.

The procedure can be performed together with a kidney transplant if the patient is also suffering from end-stage kidney failure.

Following a pancreas transplant, the patient may need to stay in the hospital for two to three weeks. It may take them a few months before they can return to their normal activities. They will be under the care of their transplant team during this time.

Patients who undergo a pancreas transplant will also need to take immunosuppressant drugs for the rest of their lives. This keeps the body from treating the new pancreas as a foreign body so it will not attack or reject it.

Possible Risks and Complications

While effective, a pancreas transplant is not considered as the primary treatment for diabetic patients. This is because the procedure carries significant risks, whereas the benefits can be gained through other means, such as regular insulin injections.

Some of the risks and potential complications that may arise during and after a pancreas transplant for diabetes include the following:

  • Organ rejection

  • Thrombosis, or blood clots in the blood vessels connected to the donor pancreas

  • Pancreatitis, or inflammation of the pancreas (this usually occurs right after transplantation but is often short-lived)

Due to the immunosuppressant medications that patients have to take to prevent organ rejection, they are also at risk of the side effects of such drugs. These include:

  • Increased susceptibility to infections

  • High blood pressure

  • Osteoporosis, or weakened bones

Most complications of pancreas transplant surgery can be treated, but it sometimes becomes necessary to remove the donor pancreas if it is causing severe health problems.

Over time, the donor pancreas can also stop working. If this happens, the patient will be included in the waiting list again for a new donor pancreas and the old donor pancreas will be removed and replaced.

References:

  • Dean PG, Kukla A, Stegall MD, Kudva YC. “Pancreas transplantation.” BMY 2017;357. http://www.bmj.com/content/357/bmj.j1321

  • Dholakia S, Mittal S, Quiroga I, et al. “Pancreas Transplantation: Past, Present, Future.” The American Journal of Medicine. July 2016(129)7:667-673. http://www.amjmed.com/article/S0002-9343(16)30199-1/fulltext

  • Jiang A, Rowe N, Sener A, Luke P. “Simultaneous pancreas-kidney transplantation: The role in the treatment of type 1 diabetes and end-stage renal disease.” Can Urol Assoc J. 2014 Mar-Apr; 8(3-4):135-138. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001637/

Share This Information: