Alternative Names pancreatic transplant, transplantation of the pancreas
Definition In pancreas transplantation, a healthy pancreas is removed from a organ donor who is brain dead and implanted into a person whose own pancreas has failed. The recipient's failed pancreas is not removed. Pancreas transplantation is used to treat diabetes. In just about all cases, the diabetes is the form that affects children and young adults, known as type I diabetes. It is a long-term condition in which the pancreas is no longer able to produce insulin.
Persons with diabetes often have chronic renal failure as well as pancreas failure. Because of this, a person may be in need of a kidney transplant. There are three types of pancreas transplant operations:
combined kidney-pancreas transplant
"pancreas after kidney" transplant, in which the pancreas is transplanted some time after a kidney has been transplanted
pancreas transplant alone
Who is a candidate for the procedure? Pancreas transplantation is only offered to persons with severe pancreatic failure. Individuals with type I diabetes ranging in age from a child to a 50 year old are possible candidates. Occasionally a person older than 50 may be considered for pancreas transplantation. However, many of them have had diabetes so long that other complications make pancreas transplant surgery too risky.
A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a pancreas transplant. This team includes surgeons, kidney specialists known as nephrologists, social workers, nurses, and transplant coordinators. A few conditions would disqualify a person from receiving a pancreas transplant. These include:
severe lung, liver, or kidney problems or complications from diabetes that would make the operation too risky
A candidate for a pancreas transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new pancreas because it is something foreign. Immunosuppressants are medications that keep the immune system from attacking the new pancreas. These medications need to be taken for as long as the new pancreas functions. The person will also need lifelong follow-up by healthcare professionals.
If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a pancreas from a donor. In 2000 there were about 54 people in Australia waiting for a pancreas transplant and 1531 waiting for a kidney transplant.
How is the procedure performed? Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain dead donor. There may be two or three teams who operate on the donor at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.
The pancreas can be preserved safely for about 12 to 15 hours. The transplant surgery needs to take place within this timeframe.
The pancreas transplant recipient is given general anaesthesia. This means that the person is put to sleep with medications and feels no pain. The person is put on a ventilator, or artificial breathing machine, during the surgery. For a pancreas transplant alone or "pancreas after kidney" transplant, a curved incision is made in the lower part of the abdomen off to one side or the other. The pancreas can be placed on the left or the right side. If a kidney transplant has already been done, the pancreas is placed on the opposite side.
If a combined pancreas-kidney transplant is to be done, the pancreas is usually placed on the right side and the kidney on the left. The pancreas is usually implanted first, followed by the kidney.
There is a major artery and a major vein that need to be connected to the new pancreas. After that, blood flow is restored to the new pancreas. Then the duodenum, which is the beginning of the small intestine, from the donor pancreas is connected to the recipient's intestine or bladder. Once all of the connections are complete, the incision is closed and the recipient is taken to the intensive care unit for recovery.
What happens right after the procedure? The pancreas transplant recipient will usually be in the hospital for 7 to 10 days. The person can usually get out of bed and start walking within 24 hours.
Immunosuppressant medications are given right before or during the surgery. Blood tests will be done in the first few weeks after transplantation to be sure that the correct dosage of the medication is being given. The recipient will continue to take these medications for the rest of his life.
Before leaving the hospital, the person will be given instructions including:
how to care for the transplant
how to take the medications
what side effects to expect
how to take care of the surgical scar
early signs and symptoms of rejection
What happens later at home? At home, the recipient can expect a slow but steady recovery. Walking is encouraged to help prevent pneumonia and other lung complications. Walking also helps the person to regain strength. Heavy lifting and straining should be avoided for several weeks. Driving is permitted once the incision heals.
What are the potential complications after the procedure? There are several complications that can affect a recipient of a pancreas transplant. Some of these can occur right after the surgery and others can occur at any time for the rest of the person's life. Complications include:
infection. Immunosuppressant medications make a person more vulnerable to infection. Some infections are minor but others can be life threatening.
major bleeding. This is rare following pancreas transplantation. However, there are many small blood vessels in the donor pancreas that need to be tied off during the operation. These vessels can bleed. Sometimes a second operation is needed to remove any blood clots and control the bleeding.
clotting of major vessels. Sometimes the major artery or vein that supplies blood to the pancreas becomes blocked, or clots. This can lead to sudden pancreas failure, and the new pancreas will need to be taken out right away.
rejection. The body's normal response to a transplanted organ is to reject it. Even though the person takes medications to prevent rejection, most recipients will have one or more episodes of rejection. These are treated by increasing the dose of the medication or switching to a different medication. If the pancreas transplant fails due to rejection, the person will need to resume taking insulin Injections.
cancer. This is another long-term problem with immunosuppressant medications. The most common cancers that develop are skin cancer and lymphoma, a cancer of the white blood cells.
Author: Robert Merion, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 28/02/2005 Contributors Potential conflict of interest information for reviewers available on request
