A pancreatic transplant is the surgical replacement of a patient’s damaged pancreas. It may be recommended for patients unable to take insulin to regulate their glucose (blood sugar) levels and those with severe hyperglycemia, hypoglycemia or other complications of type 1 diabetes.

Some patients receive a whole pancreas, but in about half of these cases the body rejects the organ. Other patients receive a partial pancreas from a living donor. Pancreas transplants are most often and most successfully performed along with a kidney transplant.

The first pancreas transplant to treat type 1 diabetes was performed in 1966. During 2005, nearly 1,500 pancreas or combined kidney-pancreas transplants were completed, according to the U.S. Scientific Registry of Transplant Recipients.

Potential candidates for a pancreas transplant are evaluated by a healthcare team. Patients whose evaluation indicates that they may be a candidate for surgery are then placed on a waiting list to receive a healthy pancreas from a donor.

After the donor organ is found, it must be transplanted into the waiting patient within 12 to 15 hours. The new organ is placed in the abdominal cavity near the damaged pancreas and attached to the blood supply and either the bladder or intestine. Recovery from the procedure may take about three weeks.  

After the procedure, the patient is given follow-up care instructions. This includes taking immunosuppressive medications to prevent the body from rejecting the organ. Periodic appointments with a physician are necessary to test the body’s response to the organ and the medications.

Patients who undergo a successful pancreas transplant are likely to have normal glucose levels and need no insulin injections. The transplant may also halt and reverse diabetes-related damage to the body.

However, a pancreas transplant is highly risky and has significant side effects, including organ rejection. Patients who undergo this procedure have an increased risk of internal bleeding, the development of blood clots, cancer and infections.

A pancreas transplant is the surgical replacement of a patient’s damaged or defective pancreas. It provides a possible treatment for patients with type 1 diabetes who also have severe kidney disease or are unable to take daily insulin for glucose (blood sugar) regulation.

After the procedure, many recipients have normal glucose levels without taking insulin. A successful pancreas transplant results in the patient no longer having diabetes for as long as the new organ functions.

The first pancreas transplant to treat type 1 diabetes occurred in 1966. Since then, the procedures have become more common. Nearly 1,500 pancreas or kidney-and-pancreas transplants were performed in 2005, according to the U.S. Scientific Registry of Transplant Recipients.

The pancreas has two main functions:

• Exocrine. Producing digestive enzymes.
• Endocrine. Producing hormones including insulin.

Insulin is essential for proper metabolism. It moves glucose through the bloodstream and allows it to enter the cells of the body to produce energy. Type 1 diabetes is an autoimmune disease in which the body mistakenly attacks and destroys the insulin-making beta cells of the pancreas.

Type 1 diabetes is usually treated by performing glucose monitoring, administering insulin as needed (often through injection), and following a diet and exercise program. Some patients are prescribed other medication (synthetic amylin) if they have unstable diabetes. In some cases, diabetes management is not successful and patients may develop complications of diabetes, including hyperglycemia, hypoglycemia and diabetic ketoacidosis.

When patients cannot take insulin or the treatment regimen ceases to be effective, a pancreas transplant may be considered. Potential candidates are evaluated by a healthcare team that may include transplant coordinators and surgeons, nephrologists (kidney specialists), endocrinologists (diabetes specialists), certified diabetes educators and social workers.

A pancreas transplant is not the best choice for all people with type 1 diabetes. Optimal candidates are 50 years of age or younger and in relatively good health. They should be free of any type of cancer for the preceding five years and have limited heart, lung or vascular disease. Patients with severe gastroparesis (autonomic neuropathy that delays stomach emptying) also are not good candidates for pancreatic transplantation. Gastroparesis can interfere with the ability to tolerate immunosuppressive drugs after surgery, which are necessary to help prevent organ rejection.

When evaluations by physicians identify patients as good candidates for surgery, they are placed on a waiting list to receive a healthy pancreas from a donor. It may take years to receive a donor organ because of the limited supply of the organs. According to the U.S. Scientific Registry of Transplant Recipients, it takes more than two years to find a donor for about half of the patients on these waiting lists.

There are several types of pancreas transplants available. In most cases, the organs come from a donor who has recently died (cadaver organs). The types of pancreas transplants include:

• Combined kidney-pancreas transplant. In most cases, a patient will receive a new pancreas and kidney during a single procedure. This can effectively treat a patient’s diabetic and renal complications. This procedure tends to be the most successful of the pancreas transplants. Transplanting both organs allows earlier detection in cases when the immune system rejects the transplant. It increases the likelihood of ending the patient’s dependence on external sources of insulin. Additionally, the pancreas helps to protect the kidney from diabetes-related damage.
  
  
• Pancreas after kidney transplant. Patients with diabetes and kidney disease may also have both organs replaced in separate procedures. The kidney is replaced first to provide normal kidney function. Later, the pancreas transplant occurs to prevent the complications that damaged the original kidneys. The majority of patients do not need insulin within a year after this type of transplant.

The transplants can also be categorized according to the quantity of pancreatic tissue being transplanted:

• Whole pancreas transplant. Patients without kidney disease, but with frequent occurrence of severe hypoglycemia or hyperglycemia (despite appropriate glucose management efforts), may be candidates for a whole pancreas transplant. These procedures are performed less often than they used to be because it is more difficult to detect the body’s rejection of just the pancreas. About half of these transplants are rejected by the patient’s body, according to the American Diabetes Association (ADA).
  
  
• Partial pancreas transplant. When a cadaver pancreas is not available, a partial pancreas from a living donor may be used. The donor may also contribute a kidney during the same procedure. In most cases, the donor is a close relative of the patient.

Transplants involving just the pancreas are associated with lower survival rates, compared to conventional treatment (e.g., insulin administration and dietary management), according to the ADA.

There is also a less-invasive but experimental procedure called islet cell transplant in which pancreatic cells are injected into the patient.

A pancreas transplant is a major surgery that involves serious risks. Patients considering this type of procedure may be able to take certain steps to improve the effectiveness of the transplant.

First, patients need to select the transplant center where they want to undergo the procedure. This can be done with recommendations from the physicians and information provided through national transplant registries. Insurance companies may also have a list of preferred providers. Next, a patient must be evaluated by a healthcare team at the designated facility before being accepted as a transplant candidate.

Candidates for a pancreas transplant are usually 50 years old or younger and have severe type 1 diabetes but otherwise are in good health. This means that they are free of cancer, chronic infections, as well as severe heart, lung or blood vessel diseases. Patients may not be accepted for a transplant if they abuse drugs or alcohol, and possibly if they smoke. In some cases, patients who smoke will need to quit smoking prior to the transplant.

Patients who can show a history of following medical instructions may improve their chances of being accepted. There are not enough of the organs available for the number of people who need a pancreas, and patients with the most positive factors for transplantation are more likely to become surgical candidates.

If the transplant center has determined that someone is a good candidate for the surgery, then the patient’s name is placed on the national organ transplant waiting list. However, this list is long, and it may be years before a pancreas is available. There were 1,516 people on the pancreas waiting list and 2,544 people on the kidney-pancreas waiting list at the end of 2005, according to the U.S. Scientific Registry of Transplant Recipients. In contrast, there were 554 pancreas transplants and 905 kidney-pancreas transplants in 2002, according to the National Kidney Foundation.

When a pancreas is donated, the record of the donation is entered into a database maintained by the United Network for Organ Sharing (UNOS). The UNOS database ensures that donated organs are distributed equally throughout the United States and match individuals in need of a transplant with organs. The compatibility of the organ and patient are estimated based on blood type, tissue proteins (e.g., HLA), and size and condition of the organ and the possible recipient. The availability of organs for recipients varies by blood type, size and organ condition.

If the pancreas and patient are compatible and the patient’s health is sufficient, the individual may be approved for the procedure.

When a pancreas becomes available, the surgery must begin quickly. The organ must be transplanted into the patient within 12 to 15 hours. The donor pancreas is removed with part of the small intestine and then packed and preserved for transport. Meanwhile, the patient is prepared for the procedure, which involves administering general anesthesia and placement on a ventilator (breathing machine).

The initial incision is made in the abdomen. The new pancreas or pancreas portion (and kidney, if necessary) is placed in the abdominal cavity near the damaged organ. Surgeons attach the blood vessels to allow blood flow through the organ and the transportation of insulin. The donated pancreas is also attached to the bladder or intestine for drainage of digestive juices.

New surgical methods are being developed that may become widely available at transplant centers in the future. Laparoscopic surgery causes less physical trauma because the incision is smaller and a tiny flexible tube is used to transplant the organ. Reduced trauma to the patient can help speed recovery from the operation.

A pancreas transplant is a major surgery and the average recovery period lasts about three weeks. The patient will likely spend the first seven to 10 days in the hospital, which will depend on surgery success and patient response. While in the hospital, the patient will likely be directed to start walking within 24 to 48 hours to help reduce the risk of blood clots developing. The patient’s sutures or clips are removed about two to three weeks after the surgery.

After the transplant, the patient and the transplant team review all pertinent information and instructions for follow-up care and medications and address any questions or concerns. The patient then undergoes a rehabilitation program, including nutrition, exercise and medications. The medications will include immunosuppressives to help prevent the body from rejecting the new organ or organs.

Follow-up appointments are required to test the body’s response to the organs and medications. These appointments are likely to initially occur weekly, but will become less frequent with time.

Rehabilitation time varies for every patient. In general, walking is recommended, although heavy lifting or straining should be avoided for several weeks after surgery. Once the incision heals, the physician will indicate when driving is permitted. Sexual activity can usually resume when the patient is comfortable, but female transplant recipients should have a discussion with the transplant team if they want to become pregnant.

The patient’s chance of a successful pancreas transplant can increase with certain lifestyle changes after the surgery. These include:

• Exercising regularly
  
  
• Maintaining a healthy weight
  
  
• Eating a good diet
  
  
• Eliminating smoking and alcohol
  
  
• Taking medications as prescribed and checking with a physician before taking any prescription or over-the-counter medication or dietary supplements
  
  
• Keeping all medical appointments
  
  
• Reporting any unusual signs or symptoms to the transplant team immediately
  
  
• Avoiding people with infections including colds and flu

Pancreas transplants offer a potential treatment for type 1 diabetes patients who are unable to regulate their glucose (blood sugar) levels through other means. For many patients, it eliminates the need for insulin therapy, reduces glucose levels and reduces dietary restrictions.

Transplants may also prevent recurrence of hypoglycemia and hyperglycemia, diabetes-related damage to blood vessels and organs, and other complications associated with the disease. In some cases, previous damage may be reversed.

Pancreas transplant surgery is not without risks and is not the solution for all patients with type 1 diabetes. For every 10 people who undergo this procedure, one to two people will die within a year, according to the American Diabetes Association (ADA). Complications that may follow a transplant include:

• Organ rejection. The immune system recognizes a new pancreas as a foreign object and produces antibodies to fight the foreign tissue. Immunosuppressive medications are prescribed to patients to reduce the risk of rejection. However, about half of patients experience pancreas rejection, according to the ADA.
  
  
• Clotting. The pancreas receives blood through a major artery and vein. When these are blocked with clots, sudden pancreatic failure can occur, requiring the removal of the transplanted pancreas.
  
  
• Bleeding. Small blood vessels may occasionally bleed after a pancreas transplant. Generally, major bleeding is rare, but if it occurs, the new organ’s blood vessels need to be tied off during surgery. A second operation may need to be performed to remove any blood clots and to control bleeding.
  
  
• Intestinal leaking. After the transplant, the bowel requires healing time, or leaking and infection can occur. This may require another operation and the possible removal of the new pancreas.
  
  
• Pancreatitis. This is inflammation of the pancreas, and it can cause pain, abnormal function of the donor organ, or the accumulation of fluid in the abdomen.
  
  
• Infection. Immunosuppressive medications help prevent the body from rejecting the new organ, but they also make a patient more susceptible to infections. Patients are required to take immunosuppressives for the rest of their lives. If infections develop, the patient may require an ongoing regimen of antifungal, antiviral and/or antibacterial drugs.
  
  
• Elevated cholesterol and hypertension (high blood pressure). These possible side effects of immunosuppressives may help reduce the risk of rejection. If necessary, additional medications to control these conditions may be prescribed.

• Cancer. Some transplant patients develop cancer at some point following the procedure. These cancers may result from the patient’s weakened immune system or as a side effect of immunosuppressive medications. Skin cancer has been shown to be the most common cancer, but breast, prostate, testicular, cervical, colon and other cancers may develop in some people.

An experimental procedure known as islet cell transplantation offer less risk of severe side effects than a pancreas transplant.

The islet of Langerhans (islet cells) within the pancreas produce and secrete hormones into the bloodstream that maintain the body’s glucose (blood sugar) levels. There are three types of these cells: alpha, beta and delta cells. The beta cells produce insulin, a lack of which leads to type 1 diabetes.

Islet cell transplantation is undergoing clinical research trials, including at a few dozen centers around North America. It involves identifying and removing islet cells from donor pancreases and then injecting the islet cells into a patient.

In addition, research into pancreas replacement may one day result in the availability of an artificial pancreas for patients with diabetes.

Preparing questions in advance can help patients have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following questions about pancreas transplants:

1. Is a pancreas transplant right for me?
   
   
2. Will this cure my diabetes?
   
   
3. What type of pancreas transplant do I need?
   
   
4. How do the types of pancreas transplant differ? Which type do you recommend for me?
   
   
5. How can I learn more about medical centers that perform pancreas transplants?
   
   
6. What are the benefits of the procedure to me? What are the risks?
   
   
7. What can be done to reduce my risks?
   
   
8. What do I need to do to prepare for the surgery?
   
   
9. How long will my recovery take? What will it involve?
   
   
10. How will I need to change my life after my transplant?
    
    
11. Are there any alternative treatments available to me?