Description

The healthy pancreas is taken from a donor who is brain dead, but is still on life support. The donor pancreas must be carefully matched to the patient who is receiving it.

A portion of the first part of the small intestine, called the duodenum, is transplanted with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.

The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the patient's abdomen. Blood vessels from the new pancreas are attached to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder.

The surgery for a pancreas transplant takes about 3 hours. However, the operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease. The combined operation takes about 6 hours.

Why the Procedure is Performed

The pancreas makes a substance called insulin. Insulin moves glucose, which is sugar, from the blood into the muscles, fat, and liver cells, where it can be used as fuel.

In people with type 1 diabetes, the pancreas doens't make enough, or sometimes any, insulin. This causes glucose to build up in the blood, leading to high blood-sugar levels. High blood sugar levels can cause many complications, including:

• Amputations
• Blindness
• Heart disease
• Kidney damage
• Nerve damage
• Stroke

A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved with surgery, however, most people with type 1 diabetes do not have a pancreas transplant soon after they are diagnosed.

• A pancreas transplant is major surgery, and people with diabetes have a high-than-normal risk of heart disease and other complications.
• People who have had a pancreas transplant will need to take several medicines for the rest of their lives. These medicines have serious side effects.

Because of these risks, pancreas transplant is rarely done alone. It is almost always done when someone with type 1 diabetes also needs a kidney transplant.

Pancreas transplant surgery may NOT be done in patients who also have:

• A history of cancer
• HIV
• Infections such as hepatitis, which are considered to be active
• Lung disease
• Obesity
• Other blood vessel diseases of the neck and leg
• Severe heart disease (such as heart failure, poorly controlled angina, or severe coronary artery disease)
• Smoking, alcohol or drug abuse, or other lifestyle habits that can damage the new organ

The doctor may also recommend against a pancreas transplant if the patient is not able to keep up with the many follow-up visits, tests, and medications needed to keep the transplanted organ healthy.

Risks

The risks for any surgery are:

• Bleeding
• Breathing problems
• Heart attack or stroke
• Infection or abscess
• Reactions to medications
• Scar formation

The risks for pancreas transplant include:

• Blood clots (deep venous thrombosis)
• Clotting (thrombosis) of the arteries or veins of the new pancreas
• Development of certain cancers after a few years
• Inflammation of the pancreas (pancreatitis)
• Leakage of fluid from the new pancreas where it attaches to the intestine or bladder
• Rejection

The body's immune system considers the transplanted organ foreign, and fights it. To prevent rejection, organ transplant patients must take drugs (such as cyclosporine and corticosteroids) that weaken the body's immune response. This makes the person less able to fight infections and can cause other medical problems.

Before the Procedure

Patients who have a pancreas transplant have chronic kidney disease along with their diabetes. Because of this, they will have the following tests before the transplant:

• Blood work to look at liver and kidney function
• Blood and urine tests to make sure there is no infection (such as HIV, hepatitis, or CMV)
• Imaging tests such as chest x-ray, cardiac catheterization, and a stress test

See Kidney transplant for more about how to prepare for a pancreas transplant.

After the Procedure

See Kidney transplant for more information.

Outlook (Prognosis)

If the transplant is successful, you will no longer need to take insulin shots, test your blood-sugar daily, or follow a diabetes diet.

There is evidence that the complications of diabetes, such as diabetic retinopathy, may not get worse -- and may even improve -- after a pancreas-kidney transplant.

More than 95% of people survive the first year after a pancreas transplant. The risks for organ rejection are about 1% each year.

You must take drugs that prevent rejection of the donated pancreas and kidney for the rest of your life.

The quality of life after a pancreas transplant has improved. Almost all patients find that managing daily life is a lot easier and more satisfying.

See: Kidney transplant for more information.

Alternative Names

Transplant - pancreas; Transplantation - pancreas

References

Lipshutz GS, Wilkinson AH. Pancreas-kidney and pancreas transplantation for the treatment of diabetes mellitus. Endocrinol Metab Clin North Am. 2007;36(4).

White SA, Shaw JA, Sutherland DE. Pancreas transplantation. Lancet. 2009; 373(9677):1808-1817.

Markmann FJ, Yeh H, Naji A, et al. Transplantation of abdominal organs. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 28.

Update Date: 5/4/2012

Reviewed by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.