Pancreas Transplant
Doctors may recommend a pancreas transplant to treat diabetes. The type of diabetes that may be treated with a pancreas transplant is usually type I or juvenile onset diabetes. With this disease, the pancreas no longer produces insulin.
Severe type I diabetes is often associated with chronic renal failure. Because of this, a person may need a kidney transplant as well as a pancreas transplant. There are three types of pancreas transplant operations:
- Combined kidney-pancreas transplant
- "Pancreas after kidney" transplant, in which the pancreas is transplanted some time after a kidney has been transplanted
- Pancreas transplant alone, for patients with functioning kidneys
The person who needs the transplant is evaluated by a pancreas transplant team and if they are found to be suitable, his or her name is placed on the waitlist. When a donated pancreas becomes available, it is surgically removed from the donor and transplanted into the patient. The recipient's failed pancreas is not removed.
Among 326 patients who underwent pancreas transplants in 1997 and 1998 (pancreas after kidney or pancreas transplant alone), about 87% survived for at least three years afterwards. Among 1,803 patients who underwent kidney-pancreas transplants in 1997 and 1998, about 89% survived for at least three years afterwards.
Step 1: Evaluating candidates for pancreas transplantation
A team of specially trained staff evaluates the patient to establish whether he or she is a good candidate for a pancreas transplant. This staff includes people with special skills in a range of areas. The people who may be on the team include:
- Nephrologists (kidney specialists) and/or endocrinologists (diabetes specialists)
- Transplant surgeons
- Social workers, psychologists, and/or psychiatrists
- Nurses
- Transplant coordinators
A pancreas transplant is only offered to people who have severe diabetes. Successful pancreas transplants have been conducted on up to the age of about 50. Pancreas transplantation in people older than 50 is less common.
The evaluating team considers many factors to decide whether a person should be placed on the waitlist for a transplant. The person's general health and suitability for major surgery are taken into account. Risk factors are also considered carefully and may result in a recommendation against transplant surgery.
A pancreas transplant would not be performed for people with certain conditions. These include:
- Most cancers, unless successfully treated at lease five years previously
- Infections that cannot be completely treated or cured, such as tuberculosis.
- Severe heart, lung, liver, or kidney problems or complications from diabetes that would make the operation too risky
It is a normal reaction of the body to reject the donated organ. Anti-rejection drugs are prescribed to prevent this rejection. The candidate must be willing to take anti-rejection medicines indefinitely to keep the body from rejecting the donor pancreas. The person will also need lifelong follow-up by healthcare professionals.
Step 2: Waiting
If a person is a suitable candidate for a pancreas transplant, their name is put on a waiting list for an organ. Unfortunately, there are many more people on the wait list than there are organs available each year. There are currently more than 3,500 people in the US waiting for a pancreas or a combined pancreas-kidney transplant. Waiting time may extend several years.
People waiting for a donor pancreas are grouped by medical factors such as blood type. Within any given group, a pancreas is allocated based on the length of time a person has been on the waitlist and, especially in the case of a kidney-pancreas transplant, on degree of match between donor and recipient.
Step 3: The Transplant Surgery
When a donor pancreas becomes available, time is important. The pancreas must be transplanted into the patient receiving the organ within 12 to 15 hours. A team of surgeons and anesthesiologists performs an operation to remove the pancreas from the donor. Additional surgical teams may be present to remove other organs. After the pancreas is removed from the donor, it is preserved and packed for transport. Although the donor is brain dead, this procedure is treated like any other operation using standard surgical practices and sterile techniques. Once the operation is complete and the incisions are closed, the donor's body is prepared for funeral or cremation. Organ procurement surgery respects the body and an open casket funeral is possible if desired.
In the meantime, a recipient is located and prepared for surgery as well. Preparations involve administration of general anesthesia and placement on a ventilator, or artificial breathing machine, during the surgery. An incision is made in the abdomen. In the case of a pancreas transplant alone, the pancreas can be placed on the left or the right side. In the case of a "pancreas after kidney" transplant, where the kidney transplant has already been done, the pancreas is placed on the opposite side to the kidney. In the case of a combined kidney-pancreas transplant the pancreas is often placed first, on the right side. The kidney is then placed on the left.
Blood flow needs to be restored to the new pancreas. A major artery and a major vein are connected to the new pancreas. After that, the beginning of the small intestine (called the duodenum) from the donor pancreas is connected to the recipient's intestine or bladder. After all of the connections have been completed, the incision is closed. The recipient is moved to the intensive care unit for recovery.
Step 4: After Transplant Surgery
Following the pancreas transplant surgery, the recipient is cared for in the hospital for 7 to 10 days. It is common for the patient to be able to get out of bed and start walking within 24 to 48 hours of the transplant.
Because the organ will be identified as foreign by the recipient's immune system, rejection of the new pancreas is always a possibility. Powerful drugs called immunosuppressants are given starting at the time of pancreas transplant surgery to try to prevent rejection. Within the first few weeks following transplantation, blood tests are done to confirm that correct dosage of medication is being dispensed.
Prior to discharge, the transplant team reviews information with the patient, gives instructions for follow-up care and medications, and answers the patient's questions. A prescribed rehabilitation program will continue at home including exercise, nutrition, and the continuation of immunosuppression and other medications. The signs of rejection are also discussed with the patient and family.
Step 5: Returning Home
At-home rehabilitation is a gradual process, and depends on the individual. The transplant team will give specific instructions. In general, walking is recommended to restore strength, but heavy lifting and straining should be avoided for several weeks following surgery. Other activities, such as driving may usually begin when the incision heals. Sexual activity can resume when one is comfortable. A desire to become pregnant should be discussed ahead of time with the transplant team to determine if and when this is recommended.
Follow-up visits are required for check-ups. These begin soon after returning home. Initially, outpatient visits may occur weekly or even more often, and as time progresses the frequency of follow-up visits usually decreases.
Possible post-operative complications may arise following pancreas transplant surgery. They include:
- Clotting of Major Vessels
- Major Bleeding
- Leaking from intestinal connection
- Pancreatitis
Clotting of major vessels - Blood is supplied to the pancreas by a major artery and vein. The artery or vein may become blocked, or clots may form. This can cause sudden pancreas failure. In that case the new pancreas will need to be removed.
Major bleeding - While major bleeding is not common after pancreas transplantation, there are some cases where small blood vessels bleed. These blood vessels in the donor pancreas need to be tied off during surgery. In some cases a second operation is performed to control bleeding and remove any blood clots.
Leaking from intestinal connection - The bowel must heal together after surgery. If it doesn't, leakage and infection may occur. This usually requires another operation for repair and often the pancreas has to be removed as a result.
Pancreatitis - Inflammation of the donor pancreas may cause fluid accumulation in the abdomen, pain or abnormal function of the donor pancreas.
Other problems include the long-term risks of immunosupression. These include complications related to too much or too little immunosuppression:
- Rejection
- Cancer
- Infection
Rejection - It is fairly common for a transplant patient to experience rejection episodes. The body identifies the new organ as foreign and may try to reject it. The immunosuppressive medications prevent rejection in 50 to 75% of cases. Changes may be made in the medications including an increase in dosage or the use of additional drugs to stop the rejection. Some episodes can cause permanent damage to the new pancreas. This may reduce longevity of the organ.
Cancer - Studies show that an estimated 6% to 8% of transplant patients will develop cancer over their lifetime with the transplant. This risk is higher than in the general population. Skin cancer is the most common, and is typically treated successfully. Some cancers result from the effects of the immunosuppressive medications and others are common cancers that occur at a higher rate in immunosuppressed individuals.
Infection - The immunosuppressant medications increase the risk of less serious and common infections such as urinary tract infection. In addition, they are associated with more serious infections like pneumonia. Finally, uncommon infections that do not affect non-immunosuppressed persons can occur.
Important! Nothing on this page is medical advice. If you need a transplant, please seek the advice and care of qualified transplant physicians. This is a general source of information and does not represent a medical opinion or recommendation.
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Section 5: Lung Transplant