Pancreas transplant

Overview

A pancreas transplant involves surgically placing a healthy pancreas from a deceased donor into someone whose own pancreas is no longer functioning. Positioned behind the stomach, the pancreas produces insulin, the hormone responsible for regulating blood sugar. When the body cannot produce enough insulin, blood sugar levels rise, which can lead to type 1 diabetes.

This type of transplant is most commonly used to address type 1 diabetes, especially in patients experiencing severe complications from the disease. Due to the potential risks and significant side effects, it is generally considered only for those with serious health issues related to diabetes. In some cases, the procedure may be used for type 2 diabetes, but this is rare.

Pancreas transplants can also be considered for certain types of cancer, such as pancreatic or bile duct cancer. Additionally, this surgery is frequently performed alongside a kidney transplant for individuals whose kidneys have been damaged by diabetes, offering a combined approach to treating both conditions.

Types

The following are several types of pancreas transplants:

• Pancreas transplant alone: Suitable for individuals with diabetes but minimal or no kidney issues. It involves placing a healthy pancreas into a recipient with a non-functioning pancreas.
• Combined kidney-pancreas transplant: Typically performed for those with diabetes and existing or high risk of kidney failure. This approach aims to provide a healthy kidney and pancreas simultaneously, reducing future kidney damage from diabetes.
• Pancreas-after-kidney transplant: For patients waiting for both organs, a kidney transplant may be done first. After recovery, a pancreas transplant is performed when a donor pancreas becomes available.
• Pancreatic islet cell transplant: This involves injecting insulin-producing islet cells from a deceased donor’s pancreas into a vein leading to the liver. It is primarily used in clinical trials for individuals with severe complications from type 1 diabetes and may require multiple injections.

Reasons for undergoing the procedure

A pancreas transplant can restore insulin production and improve blood sugar control for individuals with diabetes, though it is not a standard treatment due to the serious side effects of the required anti-rejection medications. This procedure is typically considered for people with type 1 diabetes that cannot be managed with conventional treatments, those who experience frequent insulin reactions, consistently poor blood sugar control, or severe kidney damage. In rare cases, individuals with type 2 diabetes who exhibit both low insulin resistance and low insulin production may also be eligible for a pancreas transplant.

Although type 2 diabetes is primarily characterized by insulin resistance or improper use of insulin, rather than insufficient insulin production, a small subset of patients may still benefit from a pancreas transplant. Around 15% of pancreas transplants are performed in individuals with type 2 diabetes, but this option is generally reserved for those who demonstrate both low insulin production and low insulin resistance.

Risk

Pancreas transplant surgery involves several potential risks, such as:

• Blood clots
• Excessive bleeding
• Infection
• Elevated blood sugar levels or other metabolic issues
• Urinary problems, including leakage or infections
• Donor pancreas failure
• Rejection of the transplanted pancreas

After a pancreas transplant, you’ll need to take lifelong anti-rejection medications to prevent your body from rejecting the donor organ. These medications can lead to a range of side effects, such as:

• Thinning bones
• Elevated cholesterol levels
• High blood pressure
• Nausea, diarrhea, or vomiting
• Increased sensitivity to sunlight

Additional side effects may include:

• Puffiness
• Weight gain
• Swollen gums
• Acne
• Excessive hair growth or loss

Because these drugs suppress the immune system, they can also make it more difficult for your body to fight off infections and other diseases.

Before the procedure

If your healthcare provider believes you are a candidate for a pancreas transplant, you’ll need to undergo a series of tests and evaluations to ensure you are healthy enough for the procedure.

Pre-transplant evaluations:

• Blood and urine tests: To verify your overall health and readiness for surgery.
• Medical history and physical examination: A comprehensive health review and examination.
• Immunological study: To help match you with a compatible donor.
• Imaging tests: Such as ultrasound or magnetic resonance imaging (MRI) to confirm your health status and assist in surgical planning.
• Psychological evaluation: To ensure you fully understand the surgery, including its risks and benefits.

Once approved, you will be placed on the national waiting list. Many people wait months or even years for a matching pancreas.

Staying healthy while waiting

Your healthcare team will advise you on ways to maintain your health while awaiting surgery:

• Attend medical appointments: Make sure to attend all scheduled check-ups and evaluations.
• Avoid smoking: Refrain from smoking to improve your health and transplant eligibility.
• Exercise regularly: If your health permits, stay active.
• Limit alcohol consumption: Drink in moderation or avoid alcohol entirely.
• Report health changes: Notify the transplant team if any health issues arise.
• Take medications as prescribed: Follow your prescribed treatment plan without deviations.

Preparing for surgery:

When a matching pancreas becomes available, you will need to act quickly. Take these steps to ensure you’re ready:

• Stay contactable: Ensure the transplant team can reach you at all times.
• Pack a hospital bag: Be prepared to head to the hospital on short notice.
• Notify your support network: Inform family, friends, and your employer so they can assist you when needed.

Being well-prepared and maintaining your health during the wait will help ensure a smoother transplant process when the time comes.

During the procedure

A pancreas transplant typically takes about three to five hours, with combined kidney and pancreas transplants taking nearly twice as long. An overview of the procedure is as follows::

• Anesthesia: You will be asleep under general anesthesia throughout the surgery, so you won’t feel anything.
• Incisions: The surgeon will make cuts along your abdomen, from below the breastbone down to the area beneath your belly button. In some cases, additional incisions may be made in your groin, between your abdomen and thigh.
• Transplant placement: The donated pancreas will be placed on the right side of your abdomen.
• Connections: The surgeon will attach the donated pancreas to nearby blood vessels and to your small intestine, which is part of your digestive system.
• Original pancreas: Your original pancreas will be left in place so that it can continue producing digestive juices.
• Cosing the incisions: Finally, the incisions will be closed with stitches.

After the procedure

After a successful pancreas transplant operation, your newly transplanted pancreas will begin producing insulin immediately.

Following the surgery, you will be moved to a specialized unit in the hospital where your healthcare team will closely monitor you for the following:

• Recovery from anesthesia: Ensuring a safe and smooth recovery from the effects of anesthesia.
• Organ rejection: Monitoring for signs of your body rejecting the transplanted pancreas.
• Medical issues: Ongoing assessments to detect any immediate health concerns.
• Surgical complications: Vigilant observation for any complications related to the surgery.

During this time, you will be connected to various machines and tubes to support your recovery, including:

• Oxygen: Provided to help maintain your oxygen levels.
• Fluids and nutrients: Delivered to your body as needed.
• Pain relief: Administered to manage any discomfort.
• Blood and fluid removal: Other tubes will help drain blood and fluids from the surgical site.
• Urine drainage: Tubes will be inserted to remove urine from your body.

If you recover without any complications, you will eventually be moved to a transplant recovery room. The typical hospital stay after a pancreas transplant is two to three weeks.

Outcome

Recovery timeline:

• Stitch removal: Typically occurs about three weeks post-surgery.
• Follow-up appointments: Frequent check-ups and tests are necessary for several months to ensure the surgery’s success.
• Exercise: Gentle exercise can begin after six weeks, lifting only light items.
• Time off work: Expect to take a few months off work for recovery.

Long-term outlook:

• Success rate: If there are no complications, the outlook after a pancreas transplant is usually good, with people often living years or even decades post-surgery. About half of transplanted pancreases still function well after five years. If the transplant fails, a surgeon may remove and replace the pancreas.
• Lifelong medications: Post-surgery, you will need to take immunosuppressants for life. These medications prevent your body from rejecting the new organ but can have serious side effects. Do not stop taking them without consulting your healthcare provider.
• Insulin needs: Many individuals no longer need insulin after a pancreas transplant, though some may still require it. However, episodes of low blood glucose are typically easier to manage.

Signs of infection or organ rejection:

• Aches, including headaches
• Chills
• Dizziness
• Fever higher than 100°F (37°C)
• Reduced urine output
• Nausea or vomiting
• Pain or tenderness near the pancreas
• Swelling or sudden weight gain

Your healthcare team will provide specific follow-up care instructions tailored to your situation.