Overview
Definition
A pancreas transplant is a surgical procedure to place a healthy pancreas from a donor into a person whose pancreas no longer functions properly. Almost all pancreas transplants are done to treat cases of type 1 diabetes.
Your pancreas is an organ that lies behind the lower part of your stomach. One of its main functions is to make insulin, a hormone that regulates the absorption of sugar (glucose) into your cells. Type 1 diabetes results when your pancreas can't make enough insulin, causing your blood sugar to rise to dangerous levels.
The side effects of a pancreas transplant can be significant, so pancreas transplant is typically reserved for those who have serious diabetes complications. A pancreas transplant is often done in conjunction with a kidney transplant.
Signs And Symptoms
The pancreas, located below your liver and under your stomach, is about seven inches long and weighs about 3.5 ounces. It has two main functions
The first is to help digest food by making and releasing enzymes in the upper portion of the small intestine. Carbohydrates, fats and proteins are broken down into small parts that the body uses as nourishment. In addition, the pancreas makes large amounts of sodium bicarbonate, which can make the contents of the stomach less caustic or acidic as they flow through the small intestine. Sodium bicarbonate also helps keep fluids in the body and prevent dehydration.
The other job of the pancreas is to make insulin, a hormone necessary for the body to use carbohydrates properly. If you don't produce insulin, you have a disease called diabetes.
A pancreas transplant can help manage the organ damage that may result from insulin-dependent diabetes. A successful pancreas transplant will eliminate the need for insulin injections, reduce or eliminate dietary and activity restrictions due to diabetes, and decrease or eliminate the risk of severe low blood sugar reactions .
Evaluation
For the evaluation for a pancreas transplant, we will request a number of other tests. Some of them are:
- Blood tests, including an HIV (AIDS) test, within the last year.
- Chest X-ray within the last year.
- Creatinine clearance testing for those not on dialysis. This test, conducted over a 24-hour period, compares how much creatinine — a blood waste product — occurs in the blood and in the urine to evaluate kidney function.
- Echocardiogram within the last two years. This test uses sound to create a picture of heart function.
- Electrocardiogram (EKG or ECG) within the last year.
- Persantine thallium or comparable test within the last two years. This test involves intravenous application of persantine to help expand the arteries and replicate the effect of vigorous exercise, and of thallium, a radioactive isotope detected by X-ray.
- Stool guaiac, which is a test for blood in stools.
- Tuberculosis (TB) skin test.
Other tests may be required — depending on your gender, age and medical history — such as a colonoscopy, mammogram, Pap smear or prostate specific antigen (PSA) test. Additional testing may be ordered, based on results of these tests.
Treatment
The usual treatment for diabetes is to take insulin to replace what the pancreas is not producing. Careful monitoring of blood sugar levels to achieve the correct insulin dosage may prevent or slow many diabetic complications.
Another treatment to restore insulin production is a pancreas transplant. Transplants, however, aren't recommended if patients can manage the disease through diet, medication or other means because the procedure has all the risks and recovery issues of major surgery as well as the risk of organ rejection.
To prevent rejection, patients must take powerful anti-rejection medications for the rest of their lives. These medications have many side effects and makes patients more susceptible to other illnesses.
Because there's a shortage of donor pancreases, patients must wait for an available organ. These wait periods vary depending on blood type. In general, pancreas and kidney-pancreas wait times are shorter than the wait times for a kidney alone.
Simultaneous Kidney-Pancreas Transplant
One of the most serious complications of type 1 diabetes is end-stage renal disease (ESRD) or end-stage kidney disease, which may require a kidney transplant. A kidney transplant without a pancreas transplant means you must take antirejection medication for the kidney and continue to take insulin.
The possibility of diabetes damaging the new kidney and other organs also remains. Successful combined kidney-pancreas transplants prevent diabetic damage in newly transplanted kidneys as well as eliminate the need for insulin therapy. In the best case scenario, a patient would receive a new kidney and pancreas from the same donor.
Other Kidney-Pancreas Transplant Procedures
Solitary Pancreas Transplant Pancreatic Islet Transplant
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