(See also Overview of Transplantation.)
Pancreas transplantation is done for people who have diabetes if their pancreas cannot make enough insulin. More than 80% of people who have diabetes and who receive a pancreas transplant have normal blood sugar levels afterward and no longer need insulin, but they trade this benefit for the need to take immunosuppressants, with the risk of infections and other side effects.
insulin is not considered a sufficient reason for pancreas transplantation. Thus, this procedure is usually done only in people with diabetes if
They also have kidney failure.
They cannot keep their blood sugar levels within an acceptable range, particularly if they do not sense when their blood sugar levels become too low.
Occasionally, when blood sugar levels remain too low for too long, organs, including the brain, are permanently damaged.
Because diabetes often causes kidney damage, many people who need pancreas transplantation also qualify for kidney transplantation. Overall, more than 90% of people who receive a pancreas transplant receive a kidney transplant at the same time. Kidney transplantation requires abdominal surgery and the use of immunosuppressants afterward, so transplanting a pancreas at the same time adds few risks.
Pancreas transplantation may be beneficial for people who are taking insulin but still have high blood sugar levels and whose blood sugar levels sometimes become dangerously low after taking insulin.
Sometimes only certain cells from the pancreas are transplanted (called pancreatic islet cell transplantation).
More than 95% of people survive at least 1 year after transplantation.
Both donors and recipients undergo pretransplantation screening. This screening is done to be sure that the organ is healthy enough for transplantation and the recipient does not have any medical conditions that would prohibit transplantation.
Donors
Donors are usually people who have all of the following characteristics:
They recently died.
They were aged 10 to 55.
They did not have an alcohol use disorder.
They had not had prediabetes (blood glucose levels that are higher than normal but not high enough to be labeled diabetes) or diabetes.
If both a pancreas and kidney are being transplanted, they must come from the same donor.
Parts of a pancreas from a living donor have been used, but this procedure is rarely done because the risks to the donor are high.
Procedure for Pancreas Transplantation
The procedure may involve
Transplanting a pancreas and kidney at the same time (simultaneous pancreas-kidney transplantation)
Transplanting a kidney first, then a pancreas (pancreas-after-kidney transplantation)
Transplanting only a pancreas (pancreas-alone transplantation)
Pancreas transplantation is a major operation, requiring a long incision in the abdomen and a general anesthetic. The recipient’s own pancreas is not removed.
Typically, the operation takes about 3 hours and the hospital stay is 1 to 3 weeks.
Drugs to inhibit the immune system (immunosuppressants), including corticosteroids, are started the day of transplantation. These drugs can help reduce the risk of rejection.
Complications of Pancreas Transplantation
Transplantation can cause various complications.
Rejection
Even if tissue types are closely matched, transplanted organs, unlike transfused blood, are usually rejected unless measures are taken to prevent rejection. Rejection results from an attack by the recipient's immune system on the transplanted organ, which the immune system recognizes as foreign material. Rejection can be mild and easily controlled or severe, resulting in destruction of the transplanted organ.
Despite the use of immunosuppressants, one or more episodes of rejection occurs in 20 to 40% of people after pancreas transplantation (with or without a kidney).
When a pancreas and kidney are transplanted at the same time, the risk of rejection is higher, but rejection tends to occur later and more often than when only a kidney is transplanted. Usually, both organs are rejected. However, treatment of rejection has a high success rate.
