Pancreas transplant

Overview

A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly.

The pancreas is an organ that lies behind the lower part of the stomach. One of its main functions is to make insulin, a hormone that regulates the absorption of sugar into cells.

If the pancreas doesn't make enough insulin, blood sugar levels can rise to unhealthy levels, resulting in type 1 diabetes.

Most pancreas transplants are done to treat type 1 diabetes. A pancreas transplant offers a potential cure for this condition. But it's typically reserved for those with serious complications of diabetes because the side effects of a pancreas transplant can be significant.

In some cases, pancreas transplants may also treat type 2 diabetes. Rarely, pancreas transplants may be used in the treatment of pancreatic cancer, bile duct cancer or other cancers.

A pancreas transplant is often done in conjunction with a kidney transplant in people whose kidneys have been damaged by diabetes.

Why it's done

A pancreas transplant can restore insulin production and improve blood sugar control in people with diabetes, but it's not a standard treatment. The side effects of the anti-rejection medications required after a pancreas transplant can often be serious.

Doctors may consider a pancreas transplant for people with any of the following:

• Type 1 diabetes that cannot be controlled with standard treatment
• Frequent insulin reactions
• Consistently poor blood sugar control
• Severe kidney damage
• Type 2 diabetes associated with both low insulin resistance and low insulin production

A pancreas transplant usually isn't a treatment option for people with type 2 diabetes. That's because type 2 diabetes occurs when the body becomes resistant to insulin or unable to use it properly, rather than due to a problem with insulin production by the pancreas.

However, for some people with type 2 diabetes who have both low insulin resistance and low insulin production, a pancreas transplant may be a treatment option. About 15% of all pancreas transplants are performed in people with type 2 diabetes.

There are several different types of pancreas transplants, including:

• Pancreas transplant alone. People with diabetes and early or no kidney disease may be candidates for a pancreas transplant alone. A pancreas transplant surgery involves the placement of a healthy pancreas into a recipient whose pancreas is no longer functioning properly.

• Combined kidney-pancreas transplant. Surgeons often may perform combined (simultaneous) kidney-pancreas transplants for people with diabetes who have or are at risk of kidney failure. Most pancreas transplants are done at the same time as a kidney transplant.

  The goal of this approach is to give you a healthy kidney and pancreas that are unlikely to contribute to diabetes-related kidney damage in the future.

• Pancreas-after-kidney transplant. For those facing a long wait for both a donor kidney and a donor pancreas to become available, a kidney transplant may be recommended first if a living- or deceased-donor kidney becomes available.

  After you recover from kidney transplant surgery, you'll receive a pancreas transplant once a donor pancreas becomes available.

• Pancreatic islet cell transplant. During pancreatic islet cell transplantation, insulin-producing cells (islet cells) taken from a deceased donor's pancreas are injected into a vein that takes blood to your liver. More than one injection of transplanted islet cells may be needed.

  Islet cell transplantation is being studied for people with serious, progressive complications from type 1 diabetes. It may only be performed as part of a Food and Drug Administration-approved clinical trial.

Risks

Complications of the procedure

Pancreas transplant surgery carries a risk of significant complications, including:

• Blood clots
• Bleeding
• Infection
• Excess sugar in the blood or other metabolic problems
• Urinary complications, including leaking or urinary tract infections
• Failure of the donated pancreas
• Rejection of the donated pancreas

Anti-rejection medication side effects

After a pancreas transplant, you'll take medications for the rest of your life to help prevent your body from rejecting the donor pancreas. These anti-rejection medications can cause a variety of side effects, including:

• Bone thinning
• High cholesterol
• High blood pressure
• Nausea, diarrhea or vomiting
• Sensitivity to sunlight

Other side effects may include:

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

Anti-rejection drugs work by suppressing your immune system. These drugs also make it harder for your body to defend itself against infection and disease.

How you prepare

Choosing a transplant center

If your doctor recommends a pancreas transplant, you'll be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

When you consider transplant centers, you may want to:

• Learn about the number and type of transplants the center performs each year
• Ask about the transplant center's organ donor and recipient survival rates
• Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients
• Consider other services provided by the transplant center, such as support groups, travel arrangements, local housing for your recovery period and referrals to other resources

After you've selected a transplant center, you'll need an evaluation to determine whether you meet the center's eligibility requirements.

When the transplant team assesses your eligibility, they'll consider the following:

• Are you healthy enough to have surgery and tolerate lifelong post-transplant medications?
• Do you have any medical conditions that would hinder the success of the transplant?
• Are you willing and able to take medications and follow the recommendations of the transplant team?

If you need a kidney transplant, too, the transplant team will determine whether it's better for you to have the pancreas and kidney transplants during the same surgery, or to have the kidney transplant first, followed by the pancreas transplant later. The option that's right for you depends on the severity of your kidney damage, the availability of donors and your preference.

Once you've been accepted as a candidate for a pancreas transplant, your name will be placed on a national list of people awaiting a transplant. The waiting time depends on your blood group and how long it takes for a suitable donor — one whose blood and tissue types match yours — to become available.

The average wait for a pancreas transplant is about 20 months. The average wait for a simultaneous kidney-pancreas transplant is about 14 months.

Staying healthy

Whether you're waiting for a donated pancreas to become available or your transplant surgery is already scheduled, it's important to stay as healthy as possible to increase your chances of a successful transplant.

• Take your medications as prescribed.
• Follow your diet and exercise guidelines, and maintain a healthy weight.
• If you smoke, make a plan to quit. Talk to your doctor if you need help quitting.
• Keep all appointments with your health care team.
• Stay involved in healthy activities, including those that benefit your emotional health, such as relaxing and spending time with family and friends.

If you're waiting for a donated pancreas, make sure the transplant team knows how to reach you at all times.

Once a donor pancreas becomes available, it must be transplanted into a recipient within 18 to 24 hours. You should keep a packed hospital bag handy and make arrangements for transportation to the transplant center in advance.

What you can expect

During the procedure

Surgeons perform pancreas transplants with general anesthesia, so you are unconscious during the procedure. The anesthesiologist or anesthetist gives you medication as a gas to breathe through a mask or injects a liquid medication into a vein.

After you're unconscious:

• An incision is made down the center of your abdomen.
• The surgeon places the donor pancreas and a small portion of the donor's small intestine into your lower abdomen.
• The donor intestine is attached to either your small intestine or your bladder, and the donor pancreas is connected to blood vessels that also supply blood to your legs.
• Your own pancreas is typically left in place to aid digestion.
• If you're also receiving a kidney transplant, the blood vessels of the new kidney will be attached to blood vessels in the lower part of your abdomen.
• The new kidney's ureter — the tube that links the kidney to the bladder — will be connected to your bladder. Unless your own kidneys are causing complications, such as high blood pressure or infection, they're left in place.

The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure.

Pancreas transplant surgery usually lasts about 3 to 6 hours, depending on whether you are having a pancreas transplant alone or kidney and pancreas transplants at the same time.

After the procedure

After your pancreas transplant, you can expect to:

• Stay in the intensive care unit for a couple of days. Doctors and nurses monitor your condition to watch for signs of complications. Your new pancreas should start working immediately. If your old pancreas has been left in place, it continues to perform its other functions.

  If you have a new kidney, it'll make urine just like your own kidneys did when they were healthy. Often this starts immediately. But in some cases, urine production may take up to a few weeks to return.

• Spend about a week in the hospital. Once you're stable, you're taken to a transplant recovery area to continue recuperating. Expect soreness or pain around the incision site while you're healing.
• Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for 3 to 4 weeks. Your transplant team will develop a checkup schedule that's right for you. During this time, if you live in another town, you may need to stay close to the transplant center.
• Take medications for the rest of your life. You'll take a number of medications after your pancreas transplant. Drugs called immunosuppressants help keep your immune system from attacking your new pancreas. Additional drugs may help reduce the risk of other complications, such as infection and high blood pressure, after your transplant.

Results

After a successful pancreas transplant, your new pancreas will make the insulin your body needs, so you'll no longer need insulin therapy to treat type 1 diabetes.

But even with the best possible match between you and the donor, your immune system will try to reject your new pancreas.

To avoid rejection, you'll need anti-rejection medications to suppress your immune system. You'll likely take these drugs for the rest of your life. Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.

Signs and symptoms that your body might be rejecting your new pancreas include:

• Belly pain
• Fever
• Excessive tenderness at the transplant site
• Increased blood sugar levels
• Vomiting
• Decreased urination

If you experience any of these symptoms, notify your transplant team immediately.

It's not unusual for pancreas transplant recipients to experience an acute rejection episode within the first few months after the procedure. If you do, you'll need to return to the hospital for treatment with intensive anti-rejection medications.

Pancreas transplant survival rates

Survival rates vary by procedure type and transplant center. The Scientific Registry of Transplant Recipients maintains current statistics regarding transplantation for all U.S. transplant centers.

Pancreas rejection rates tend to be slightly higher among pancreas-only transplant recipients. It's unclear why results are better for those who receive a kidney and pancreas at the same time. Some research suggests that it may be because it's more difficult to monitor and detect rejection of a pancreas alone versus a pancreas and a kidney.

If your new pancreas fails, you can resume insulin treatments and consider a second transplant. This decision will depend on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.