• Pancreas transplantation

    A pancreas transplant is an effective procedure enabling a person with type 1 (or juvenile) diabetes to become insulin independent. In an overwhelming majority of the cases, the recipient also receives a kidney transplant either simultaneously or preceding the pancreas transplantation. Roughly 10 percent of the 1,200 procedures performed annually involve just the pancreas.

    What does the pancreas do?

    Located under the stomach, the pancreas is the organ responsible for producing the hormone insulin and digestive juices. Insulin allows the body to open its cells, which receives a simple sugar called glucose and uses it to create energy. Without insulin, the cells cannot receive glucose and the sugar remains in the blood stream. If the individual’s blood sugar count remains high, it can cause significant damage to their eyes, kidneys, nerves and heart. A type 1 diabetic is unable to produce the insulin needed to make that important conversion and must take daily insulin injections to process the glucose in their body.

    If successful, the recipient will no longer have type 1 diabetes, eliminating the need for the injections. However, the recipient will need to take immunosuppressants, otherwise known as anti-rejection medications, for the rest of their life to keep the body from damaging the new pancreas. The drug therapy will vary based on the doctor’s recommendations and the patient’s needs. Patients should consult with their surgeon about possible side effects from the prescribed treatment. (NOTE: A pancreas transplant is not considered an effective therapy for people with type 2 diabetes as that disease is due to lifestyle and dietary choices.)

    The procedure

    The surgery begins with a central incision under the rib cage in the abdominal area. If the pancreas transplant occurs at the same time as a kidney transplant, surgeon will start with the kidney first. Unlike other transplantation procedures, the individual’s original pancreas stays in the body. This allows the body to retain the use of its own digestive juices. Because of this, surgeons will place the individual’s new pancreas in the lower abdominal area.

    In most cases, the donor organ will come from a deceased individual and the recipient will receive the entire pancreas. However, there are instances when the donated organ will come from a living donor. In those instances, the recipient will receive only a portion of the pancreas. In addition to the pancreas, a portion of the donor’s small intestine is transplanted as well. The donor intestine is used to attach the new pancreas to either the recipient’s intestines or bladder, to excrete the digestive juices from the new pancreas. Sufficient blood flow is essential to the long-term success of the transplanted pancreas. Surgeons will make sure both the organ and intestine have strong arterial and portal vein connections by attaching the pancreas to the vessels in the groin that control blood flow to the legs. The surgery is typically completed within two to four hours.

    Post-operative care and complications

    Once the surgery is finished, the recipient is observed in an intensive care unit with staff maintaining a close watch on their blood sugar level. If there are no immediate signs of rejection nor complications after the surgery, the patient could be discharged from the hospital in as few as 7 to 14 days.

    Even after the patient leaves the hospital, rejection of the new organ remains a major concern. Symptoms that the body is rejecting the new organ include: fever, abdominal distress, vomiting and an increase in blood sugar levels. Patients with these symptoms should contact their doctor or surgeon immediately. It is not uncommon for recipients to experience at least one rejection episode, especially within a few weeks after the surgery. The episodes could be severe enough to trigger additional hospital stays.