Pancreas Transplant

Pancreas Transplant

A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly.

Your pancreas is an organ that lies behind the lower part of your stomach. One of its main functions is to make insulin, a hormone that regulates the absorption of sugar (glucose) into your cells.

If your pancreas doesn’t make enough insulin, blood sugar levels can rise to unhealthy levels, resulting in type 1 diabetes.

Most pancreas transplants are done to treat type 1 diabetes. A pancreas transplant offers a potential cure for this condition. But it is typically reserved for those with serious diabetes complications, because the side effects of a pancreas transplant are significant.

In some cases, pancreas transplants may also treat type 2 diabetes. Rarely, pancreas transplants may be used in the treatment of pancreatic, bile duct or other cancers.

A pancreas transplant is often done in conjunction with a kidney transplant in people whose kidneys have been damaged by diabetes.

A pancreas transplant can restore normal insulin production and improve blood sugar control in people with diabetes, but it’s not a standard treatment. The side effects of the anti-rejection medications required after a pancreas transplant can often be serious.

For people with any of the following, a pancreas transplant may be worth considering:

Type 1 diabetes that can’t be controlled with standard treatment
Frequent insulin reactions
Consistently poor blood sugar control
Severe kidney damage
Type 2 diabetes associated with both low insulin resistance and low insulin production
A pancreas transplant usually isn’t a treatment option for people with type 2 diabetes, because type 2 diabetes occurs when the body becomes resistant to insulin or unable to use it properly rather than due to a problem with insulin production in the pancreas.

But for some people with type 2 diabetes who have both low insulin resistance and low insulin production, pancreas transplant is an emerging treatment option. About 10 percent of all pancreas transplants are performed in people with type 2 diabetes.

There are several different types of pancreas transplants, including:

Pancreas transplant alone. People with diabetes and early or no kidney disease may be candidates for a pancreas transplant alone (solitary pancreas transplant). A pancreas transplant surgery involves only a pancreas transplant without other surgeries.
Combined kidney-pancreas transplant. Surgeons often may perform combined (simultaneous) kidney-pancreas transplants for people with diabetes who have or are at risk of kidney damage. More than two-thirds of pancreas transplants are done simultaneously with a kidney transplant.

The goal of this approach is to give you a healthy kidney and pancreas that are unlikely to contribute to diabetes-related kidney damage in the future. But waiting for a donor pancreas and kidney to become available at the same time may increase time spent on the organ donor waiting list.

Pancreas-after-kidney transplant. For those facing a long wait for both a donor kidney and pancreas to become available, a kidney transplant may be recommended first if a living- or deceased-donor kidney becomes available.

After you recover from kidney transplant surgery, you’ll receive the pancreas transplant once a donor pancreas becomes available.

Pancreatic islet cell transplant. During pancreatic islet cell transplantation, insulin-producing cells (islet cells) taken from a deceased donor’s pancreas are injected into a vein that takes blood to your liver. More than one injection of transplanted islet cells is often necessary.

Islet cell transplantation is an experimental procedure and may only be performed as part of a Food and Drug Administration-approved clinical trial.

Although it’s possible for a living donor to donate part of a pancreas, nearly all pancreas transplants involve a deceased-donor pancreas.

Pancreas transplant surgery carries a risk of significant complications, including:

Blood clots
Bleeding
Infection
Excess sugar in the blood (hyperglycemia) or other metabolic problems
Urinary complications, including leaking or urinary tract infections
Failure of the donated pancreas
Rejection of the donated pancreas
Anti-rejection medication side effects

After a pancreas transplant, you’ll take medications for the rest of your life to help prevent your body from rejecting the donor pancreas. These anti-rejection medications can cause a variety of side effects, including:

Bone thinning (osteoporosis)
High cholesterol
High blood pressure
Nausea, diarrhea or vomiting
Sun sensitivity
Puffiness
Weight gain
Swollen gums
Acne
Excessive hair growth or loss
All anti-rejection drugs work by suppressing your immune system, which also makes it harder for your body to defend itself against infection and disease.

If your doctor recommends a pancreas transplant, you’ll be referred to a transplant center. You’re also free to select a transplant center on your own or choose a center from your medical aid insurance company’s list of preferred providers.

When the transplant team assesses your eligibility, they’ll consider the following:

Are you healthy enough to have surgery and tolerate lifelong post-transplant medications?
Do you have any medical conditions that would hinder transplant success?
Are you willing and able to take medications and follow the suggestions of the transplant team?
If you need a kidney transplant, too, the transplant team will determine whether it’s better for you to have the pancreas and kidney transplants during the same surgery, or to have the kidney transplant first, followed by the pancreas transplant at a later date. The option that’s right for you depends on the severity of your kidney damage, the availability of donors and your preference.

Once you’ve been accepted as a candidate for a pancreas transplant, your name will be placed on a national list of people awaiting a transplant. The waiting time for a transplant depends on your blood group and how long it takes for a suitable donor — one whose blood and tissue types match yours — to become available.

The average wait for a pancreas transplant is about 18 months. The average wait for a simultaneous kidney-pancreas transplant is about 20 months.However this is a mere indicator and has no guarantee.

Staying healthy

Whether you’re waiting for a donated pancreas to become available or your transplant surgery is already scheduled, it’s important to stay as healthy as possible to increase your chances of a successful transplant.

Take your medications as prescribed.
Follow your diet and exercise guidelines.
Keep all appointments with your health care team.
Stay involved in healthy activities, including those that benefit your emotional health, such as relaxing and spending time with family and friends.
If you’re waiting for a donated pancreas, make sure the transplant team knows how to reach you at all times.

Once a donor pancreas becomes available, it must be transplanted into a recipient within 15 hours. You should keep a packed hospital bag handy and make arrangements for transportation to the transplant center in advance.

Pancreas transplant
Surgeons perform pancreas transplants with general anesthesia, so you’re unconscious during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas to breathe through a mask or injects a liquid medication into a vein.

After you’re unconscious:

An incision is made down the center of your abdomen.
The surgeon places the new pancreas and a small portion of the donor’s small intestine into your lower abdomen.
The donor intestine is attached to either your small intestine or your bladder, and the donor pancreas is connected to blood vessels that also supply blood to your legs.
Your own pancreas is left in place to aid digestion.
If you’re also receiving a kidney transplant, the blood vessels of the new kidney will be attached to blood vessels in the lower part of your abdomen.
The new kidney’s ureter — the tube that links the kidney to the bladder — will be connected to your bladder. Unless your own kidneys are causing complications, such as high blood pressure or infection, they’re left in place.
The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure with a blood pressure cuff on your arm and heart monitor leads attached to your chest.

Pancreas transplant surgery usually lasts about two to four hours. Simultaneous kidney-pancreas transplant surgery takes a few more hours.

After the procedure

After your pancreas transplant, you can expect to:

Stay in the intensive care unit for a couple days. Doctors and nurses monitor your condition to watch for signs of complications. Your new pancreas should start working immediately, and your old pancreas will continue to perform its other functions.

If you have a new kidney, it’ll make urine just like your own kidneys did when they were healthy. Often this starts immediately. But in some cases, it may take up to a few weeks to reach normal urine production.

Spend about one week in the hospital. Once you’re stable, you’re taken to a transplant recovery area to continue recuperating. Expect soreness or pain around the incision site while you’re healing.
Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for three to four weeks. Your transplant team will develop a checkup schedule that’s right for you. During this time, if you live in another town, you may need to make arrangements to stay close to the transplant center.
Take medications for the rest of your life. You’ll take a number of medications after your pancreas transplant. Drugs called immunosuppressants help keep your immune system from attacking your new pancreas. Additional drugs may help reduce the risk of other complications, such as infection and high blood pressure, after your transplant.
Results
After a successful pancreas transplant, your new pancreas will make the insulin your body needs, so you’ll no longer need insulin therapy to treat type 1 diabetes.

But even with the best possible match between you and the donor, your immune system will try to reject your new pancreas.

To avoid rejection, you’ll need anti-rejection medications to suppress your immune system. You’ll likely take these drugs for the rest of your life. Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.

Belly pain
Fever
Excessive tenderness at the transplant site
Increased blood glucose levels
Vomiting
Decreased urine output
If you experience any of these symptoms, notify your transplant team immediately.

It’s not unusual for pancreas transplant recipients to experience an acute rejection episode within the first few months after the procedure. If you do, you’ll need to return to the hospital for treatment with intensive anti-rejection medications.

In a pancreas transplant, the donor pancreas is attached to the small intestine with a portion of the donor’s small intestine. Once the new donor pancreas is in place, it replaces the function of the diseases pancreas by releasing insulin and other enzymes into the gastrointestinal tract.

Survival rates vary by procedure type and transplant center. Pancreas rejection rates tend to be slightly higher among pancreas-only transplant recipients. It’s unclear why results are better for those who receive a kidney and pancreas at the same time. But some research suggests it may be because it’s more difficult to monitor and detect rejection of a pancreas alone versus a pancreas and a kidney.

If your new pancreas fails, you can resume insulin treatments and consider a second transplant. This decision will depend on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life.

Explore studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

It’s normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Seeking the support of friends and family members can help you cope during this stressful time.

Your transplant team can also assist you with other useful resources and coping strategies throughout the transplant process, such as:

Joining a support group for transplant recipients. Talking with others who have shared your experience can ease fears and anxiety.
Sharing your experiences on social media dedicated to helping transplant recipients and donors connect to each other online.

Recognize that life after transplant may not be exactly the same as life before transplant. Having realistic expectations about results and recovery time can help reduce stress.
Educating yourself. Learn as much as you can about your procedure and ask questions about things you don’t understand.

Knowledge is empowering.
New medication options

Researchers actively study medications and treatments for people with pancreas transplants. Current research includes comparing and developing new anti-rejection medication (immunosuppressive) regimens to keep your body from rejecting your pancreas transplant.

For example, researchers are looking at ways to personalize immunosuppression maintenance regimens after pancreas transplant by using immune system monitoring.

They also study the possibility of lowering the dose of immunosuppressive medications, such as calcineurin inhibitors, to reduce side effects.

After your pancreas transplant, you should adjust your diet to keep your pancreas healthy and functioning well. Maintaining a healthy weight through diet and exercise can help prevent many common post-transplant complications, including infection, heart attacks and bone thinning.

Your transplant team includes a nutrition specialist (dietitian) who can discuss your nutrition and diet needs and answer any questions you have after your transplant.

Your dietitian will also provide you with several healthy food options and ideas to use in your nutrition plan. Your dietitian’s recommendations may include:

Eating at least five servings of fruits and vegetables each day
Eating lean meats, poultry and fish
Eating whole-grain breads, cereals and other products
Having enough fiber in your daily diet
Drinking low-fat milk or eating other low-fat dairy products to help maintain healthy calcium levels
Limiting salt and sodium intake by using fresh herb and spices to season foods and avoiding processed foods
Limiting unhealthy fats, such as saturated fats in butter and red meats
Limiting your caffeine
Avoiding excessive alcohol
Staying hydrated by drinking adequate water and other fluids each day
Avoiding grapefruit and grapefruit juice, pomegranate and Seville oranges due to their effect on a group of immunosuppressive medications (calcineurin inhibitors)
Following food safety practices to reduce the risk of infection

Exercise
Exercise and physical activity should be a regular part of your life after a pancreas transplant to continue improving your overall physical and mental health.

After a transplant, regular exercise helps boost energy levels and increase strength. It also helps you maintain a healthy weight, reduce stress and prevent common post-transplant complications such as high blood pressure and cholesterol levels.

Your transplant team will recommend a physical activity program based on your individual needs and goals.

Soon after your transplant, you should walk as much as you can. Then start incorporating more physical activity into your daily life, including participating in at least 30 minutes of moderate exercise five days a week.

Walking, bicycling, swimming, low-impact strength training and other physical activities you enjoy can all be a part of a healthy, active lifestyle after transplant. But be sure to check in with your transplant team before starting or changing your post-transplant exercise routine.

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