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Pancreas transplant

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Overview

Pancreas transplant is a procedure that involves implanting a healthy pancreas into a person who is suffering from diabetes. As the pancreas is a vital organ, performing functions necessary in the digestion process,  The pancreas is obtained from a person who has died recently and has generously donated his/her organs.

What is a pancreas and what does it do?

The pancreas is an organ located inside the abdomen (tummy). It is about 6-8 inches in length and 2-3 inches in breadth. It is located in the upper middle part of the abdomen, deep to the stomach and lying on the left kidney.

It produces enzymes that break down the food we eat so, that the nutrients can be absorbed properly. It also produces a range of hormones that are needed for the body to perform functions like maintaining blood sugar level, regulating energy production to meet the demands of the body. 

One such hormone is insulin, which is responsible for lowering blood glucose (sugar) levels. It is produced by specialized cells within the pancreas called islets.

People with insulin-dependent diabetes (also known as type I diabetes), the pancreas no longer produces enough insulin to fulfil the demands of the body. They need to be on regular insulin injections, to keep blood sugar levels within safe limits.

Who needs a pancreas transplant?

The transplanted pancreas produces insulin that cares about the body’s metabolic needs.

Insulin injections are effective in the treatment of such diabetes, and pancreas transplant is appropriate for only a small percentage of patients with type I diabetes. The surgical procedure is in itself an extensive procedure and carries risks.

A pancreas transplant may be advised if:

  • A patient has severe kidney disease (on regular dialysis mostly). Though diabetes is the common cause for such kidney disease, other diseases may also be responsible. In such cases, a pancreas transplant is carried out alongside a kidney transplant.
  • In complicated cases of Type I diabetes, where a person has repeated and severe low blood sugar level despite good insulin control.
  • Pancreas-kidney transplant may prove beneficial for selected patients suffering from type 2 diabetes.
  • The transplanted pancreas starts producing insulin, thereby negating the need for treatment with insulin injections. It also prevents further damage to different organs (for example- eyes, kidneys, nerves) caused by a lack of insulin.
  • The patient is carefully assessed to determine whether he/she needs a pancreas transplant and whether the transplant will be beneficial for the patient in the long run.
  • The patient is also assessed meticulously by a team of doctors to find out whether he/she is healthy enough to undertake the surgical procedure. 
  • In selected patients, only a pancreas transplant is recommended instead of combined pancreas-kidney transplant.
  • It is mainly recommended in patients who are suffering from type I diabetes whose kidney functions are not severely compromised.
  • Also, in certain patients who already had a kidney transplant before, a pancreas transplant may be recommended.

How to prepare for a pancreas transplant?

A detailed assessment is carried out in the transplant centre to find out about the patient’s health and ability to cope with the procedure. The patient often needs to get admitted for a few days to carry out such an assessment and tests.

The tests include:

  • Check on blood pressure and heart rate
  • Measurements of height and weight
  • Urine and blood tests
  • Chest X-ray
  • Duplex scan – a type of ultrasound (USG) to examine blood vessels
  • Tests of the heart – ECG, echocardiography

Who might not be suitable for a pancreas transplant?

Not everyone is suitable for a pancreas transplant. This is because the operation places a major stress on the body, and the risks may outweigh the potential benefits.

For example, a pancreas transplant may not be considered appropriate in presence of:

  • Severe heart disease
  • The recent history of heart attack
  • Incurable cancer
  • Serious mental health issues
  • Fraility and poor health, making it unlikely for the patient to be able to tolerate the procedure and the treatment thereafter
  • Extreme obesity
  • Alcohol or drug addiction
  • Age isn't a factor in determining the suitability of a pancreas transplant. 

The process of Pancreas Transplant

Once a patient is assessed as being suitable for a pancreas transplant, he/she is placed on a waiting list by registering as a suitable recipient.

The NOTTO (National Organ & Tissue Transplant Organization) maintains a list of potential recipients. Our team will guide you through the registration process.

 The waiting time for a suitable pancreas may be considerably longer or in a few cases, many patients would never get an organ. The transplant centre will offer support, guidance and information while one waits for a suitable donor pancreas to be found.

It is essential to stay as healthy as possible while waiting for a pancreas to be available. This can be done by:

  • taking prescribed medications appropriately
  • having a healthy diet
  • taking regular exercise, if possible
  • avoiding smoking, alcohol

The patient should make appropriate arrangements with family, friends and employer to undertake the procedure whenever a pancreas becomes available, which may be on a short notice. Once a suitably matched donor of the pancreas is found, the patient is contacted by the transplant coordinator and asked to come to the centre.  

Once a patient is called for transplant, he/she

  • should not eat or drink anything (unless blood sugar is very low)
  • bring all current medicines along with

Once in the hospital, the patient is reassessed quickly to make sure no new medical conditions have developed.

What happens during a pancreas transplant?

The surgery is carried out under general anaesthesia, which means that the patient is put to sleep and doesn’t feel anything during the surgery.

  • A cut (incision) is made in the abdomen, from just below the breastbone to below the belly button.
  • The donor pancreas is usually placed in the right side of the abdomen and is connected to the blood vessels that carry blood down to the leg.
  • To drain the digestive juices produced by the pancreas, a small part of the donor’s small intestine which remains attached to the donor pancreas is connected to the patient’s small intestine or the urinary bladder.
  • In case of a combined pancreas and kidney transplant, the kidney is placed on the left side of the abdomen.
  • The old pancreas is not removed as it will continue to produce digestive juices while the donor pancreas produces insulin.
  • The surgical procedure takes complete four to five hours. The new pancreas starts producing insulin straight away.

Process of recovery 

Once, the surgery is done, the patient is shifted to the intensive care unit (ICU) where he/she stays for a few days. And once everything is ok, He/she is shifted to the ward for a few days.

The patient stays in hospital for around 3 weeks after a pancreas transplant. A period of rest is advised after the procedure, and normal activities can be resumed in a few months.

The patient needs to be on lifelong follow up after transplant. 

The patient will also be started on medicines called immunosuppressants soon after the transplant. These are given so that the donor pancreas is not rejected by the patient’s own body. These medicines have to be taken for the rest of life.

Risks of a pancreas transplant

As with all types of surgeries, there is a risk of complications. After this procedure as well, There are some complications that can occur soon after the procedure, while others may develop months, or even years, later.

Possible complications may include

  • Rejection- the body treats the donor pancreas as foreign and mounts a response against it, causing loss of function of the donated pancreas.
  • Blood vessels supplying the donor pancreas may get clotted (thrombosis)
  • Inflammation of the pancreas (pancreatitis)
  • Side effects from the immunosuppressant medicines like high blood pressure, increased risk of catching infections, weakened bones.

Most of the complications are treatable successfully, however, in some rare circumstances, the donor pancreas may have to be removed.

Outlook after a pancreas transplant

The outlook of most of the patients with pancreas transplant is usually good. Most of the patients live for many years after a transplant, and almost 90% will live for at least 5 years.

Follow-up appointments after transplant

The patient needs to have regular follow up and checkups after discharge. The visits are frequent at first but may eventually only be necessary once every few months.

Life after a successful pancreas transplant

  • One should be able to return to most of the normal activities after the procedure, though this may take a while.
  • Insulin will not be needed anymore in most of the cases and dietary restrictions can also be significantly waived off.
  • Though light lifting is often possible after six weeks, a patient shouldn't lift anything heavy, such as a shopping bag, for a few months.
  • More vigorous activities, such as contact sports, may not be recommended – at least in the short-term – as they could injure the new pancreas.
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