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.
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.
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.
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. The timing of surgery depends on the availability of a donated living or cadaver organ.
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.
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.