Pancreas Transplant - Benefits and Risks

Introduction:

The pancreas is a gland, about 6 inches long, located behind the stomach and below the liver in the abdomen. The vital functions of the pancreas include aiding in digestion and the production of hormones. Enzymes secreted by the pancreas help break down complex food substances into simpler forms that can be easily absorbed into the bloodstream. The other most important function of the pancreas is the production of a hormone called insulin, which regulates the levels of sugars in the blood. Insulin helps glucose to enter the cells. The absence of insulin or resistance to insulin leads to the build-up of glucose in the blood, causing diabetes.

What Is a Pancreas Transplant?

A pancreas transplant is a surgical procedure in which a healthy pancreas from a deceased donor is transplanted in a patient whose pancreas fails to function properly. It is done in patients with type 1 diabetes, in whom the pancreas does not produce insulin, leading to increased blood sugars. In most patients, a transplant cures the problem. However, the surgery is reserved for people only with serious complications of diabetes as there are risks involved post-transplant. In a few cases, patients with type 2 diabetes may need a pancreas transplant.

A pancreas transplant is planned along with a kidney transplant in diabetic patients who have kidney failure. Surgery for a pancreas transplant may take up to three hours, whereas a pancreas-kidney transplant together may take up to six hours.

The aim of a pancreas transplant is to restore normal insulin production and improve blood glucose control in people with poorly controlled diabetes. However, serious side effects can occur because of anti-rejection medications that are advised after surgery. Anti-rejection medications help prevent the transplant from being rejected in the body; however, these medicines act by reducing the immunity in the body, making the patient more vulnerable to all kinds of infections. Also, these medicines have to be taken lifelong by the patient.

Who Is More Preferred to Undergo a Pancreas Transplant?

Doctors may consider pancreas transplant for patients with the following conditions, which include:

• Type 1 diabetes cases that do not respond to normal treatment.

• Patients with poorly controlled blood sugars.

• Patients with severe kidney damage.

• Diabetics with frequent occurrence of insulin reactions.

• Type 2 diabetics with low insulin resistance and low insulin production.

What Are the Different Types of Pancreas Transplants?

There are different types of pancreas transplants, which include:

• Pancreas Transplant Alone: Also known as solitary pancreas transplant, the surgery involves placing a healthy pancreas in patients with diabetes and with little or no kidney disease.

• Combined Kidney Pancreas Transplant: Combined kidney-pancreas transplants are done in patients with diabetes who have or are at an increased risk for kidney failure. Both pancreas and kidney are transplanted at the same time. The pancreas is taken from a deceased donor, whereas a kidney can be taken from a deceased or living donor.

• Pancreas-After-Kidney Transplant: In cases where there is a long wait for the donor pancreas to be available, the pancreas after kidney transplant is preferred. Surgery is first done to transplant a kidney from a living or deceased donor, and once the patient heals post-surgery and based on the availability of a donor pancreas, a pancreas transplant is carried out.

• Pancreatic Islet Cell Transplant: In this procedure, islet cells from the deceased donor’s pancreas are injected into a vein that carries blood to the liver. Islet cells produce insulin, a hormone that controls blood sugars. Studies are being carried out for islet cell transplantation in patients with type 1 diabetes with complications.

Why Is a Pancreas Transplant Performed?

A pancreas transplant is usually planned in type 1 diabetic patients who have poorly controlled blood sugars and complications related to high blood sugars. In most cases, the surgery is planned along with a kidney transplant. The aim of a pancreas transplant surgery is to restore the blood sugar levels to normal and also prevent complications related to diabetes. However, as the risks of surgery are high, it is only preferred in patients in whom the advantages of surgery outweigh the risks.

The complications of long-standing uncontrolled blood sugars include:

• Kidney damage.

• Nerve damage.

• Problems of the eye.

• Stroke.

• Diseases of the arteries.

• Amputations (removal of an infected, non-healing limb to prevent infection from spreading to other body parts).

A pancreas transplant is not recommended in people having the following conditions, which include:

1. A history of cancer.

2. Lung diseases.

3. Heart diseases.

4. Liver conditions like hepatitis (inflammation of the liver caused by viral infection).

5. AIDS (Acquired immunodeficiency syndrome - a viral infection that attacks the body’s immune system).

6. Habits like smoking, alcohol, or drug abuse can damage the newly transplanted organ.

7. Patients who cannot keep up regular follow-ups or those who do not take medicines properly.

What Are the Risks of a Pancreas Transplant?

Risks associated with a pancreas transplant can be due to complications of the procedure or anti-rejection medicines side effects.

Risks due to complications of surgery include:

• Bleeding.

• Infection.

• Formation of blood clots.

• Rejection or failure of the transplanted pancreas.

• Excess blood sugars.

• Urinary problems like leaking or infections of the urinary tract.

Anti-rejection medication side effects include:

These medications are prescribed to prevent the rejection of the transplanted organ by the body. Anti-rejection medicines have to be used lifelong. The side effects which occur with these medicines include:

• Nausea and vomiting.

• Diarrhea.

• High Blood pressure.

• High cholesterol.

• Thinning of bones.

• Weight gain.

• Acne.

• Swelling of gums.

• Excess hair loss or hair growth.

• Recurrent infections due to suppression of the immune system.

How to Choose a Transplant Center?

Doctors recommend a transplant center, or the patient can choose one based on the list provided by the insurance companies.

When considering a transplant center, the patient would like to know about the number or types of transplants done by the center and also the success rates of transplants.

After the selection, the center evaluates the patient and whether they meet the eligibility criteria like:

• Is the patient healthy enough?

• Can they tolerate post-surgery medications?

• Do they have any health issues that hinder a successful transplant?

• Will the patient be able to follow recommendations by the transplant center?

• Do they need only a pancreas transplant or a combination of kidney-pancreas transplants?

After completion of the necessary criteria, the patient’s name will be added to the national list for people awaiting a transplant. A kidney-pancreas transplant may take up to 13 months of waiting time, whereas a pancreas transplant may take a waiting time of about 23 months.

How to Stay Healthy Before the Procedure?

When the patient is waiting for a transplant, staying healthy throughout helps in successful transplant surgery. The patient may be recommended to:

• Follow a healthy diet.

• Maintain a healthy exercise routine.

• Take care of emotional health.

• Take the prescribed medications.

• Quit smoking.

• Reachable at all times as the transplant procedure is planned in 18 to 24 hours, once the donor organ is available.

What to Expect During the Procedure?

The transplant surgery is carried out in general anesthesia (a medically induced sleep-like state to carry out a medical procedure).

During the procedure, the surgeon makes a cut (incision) in the lower part of the abdomen. The donor pancreas and a part of the donor’s small intestine are placed in the lower abdomen. The donor pancreas is connected to the blood vessels that supply the legs, whereas the donor's small intestine is attached to the patient’s small intestine or bladder. The patient’s pancreas is left to help aid in digestion.

If the surgery also involves a kidney transplant, the new kidney is attached to the blood vessels of the lower part of the abdomen. The ureter (the tube that links the kidney to the bladder) is attached to the patient’s bladder. The patient’s own kidney is left in place if it does not cause any complications like high blood pressure.

The surgery can last for about three hours for a pancreas transplant alone and from three to six hours for a kidney-pancreas transplant together. The doctors monitor the heart rate, blood pressure, and blood oxygen throughout the surgery.

What to Expect After the Procedure?

The new pancreas and kidney start functioning almost immediately after the transplant, in case of no complications. The following steps need to be followed post-surgery, which include:

• Stay in the intensive care unit (ICU) for a couple of days.

• Stay in the hospital for about a week.

• Go for frequent checkups.

• Continue taking medications for the rest of your life.

What Are the Results of Pancreas Transplant?

Pancreas transplant surgery can be successful when the best possible match is found. However, the patient has to take anti-rejection medications for the rest of their lives. Also, these medicines make the patient more vulnerable to infections; hence the doctor may prescribe antibacterial and antiviral medicines additionally.

Signs and symptoms which indicate rejection of transplant include:

1. Abdominal pain.

2. Tenderness at the site of the transplant.

3. Fever.

4. Vomiting.

5. Increased blood glucose levels.

Conclusion:

A pancreas transplant is planned in diabetic patients in whom the pancreas does not work properly. After successful post-transplant, the patient may not need insulin shots or need to check blood sugars on a daily basis; also, the diabetic complications may not worsen. Anti-rejection medications are advised to be used for their entire lives, which can hinder the immunity of patients. Organ rejection occurs in only about 1 percent of cases. Maintaining a healthy lifestyle consisting of exercise and good dietary habits is recommended for transplant patients.