Pancreas Transplants

The pancreas is an organ located near the lower part of the stomach.  The pancreas has basically two functions: it helps the body digest food and it helps the body use food.  Islets of Langerhans (also called islets or islet cells) are clusters of cells that contain cells that regulate blood glucose.  The alpha cells make glucagon, which raises the level of blood glucose.  The beta cells make insulin, which lowers the level of blood glucose.  Pancreas and islet transplantation are two forms of beta cell replacement therapy that may help people with diabetes regulate their blood sugar.

Pancreas transplants have been performed since 1966 and are an accepted standard of medical care. Pancreas transplants are very successful in helping people with insulin-dependent diabetes improve their blood sugar and reduce the long-term complications of diabetes.

Types and Qualifying Criteria
What to Expect
Outcomes

What to Expect

How a Pancreas Transplant is Performed

The transplant recipient's own organs are left in place and the new organs are placed in the lower abdomen.  Preferably, the pancreas goes to the right of the bladder and the kidney (when needed) to the left. 

The pancreas can be procured in one of two ways: it can be procured from a deceased organ donor or half of a pancreas can be procured from a living organ donor.  In the case of a deceased organ donor, the duodenum (a part of the small intestine) is also transplanted because the head of the pancreas is intimately attached to it.  In the case of a living organ donor, the tail of the pancreas is the part that is used.

Once procured, the donated pancreas is prepared by the surgeons to be put into the transplant recipient.  Both extremes of a deceased donor duodenum are closed and a new opening is made.  The donated pancreas is then attached to three places in the transplant recipient:

1. The portal vein coming from the donated pancreas is sewn to the recipient's iliac vein.

2. The pancreas arteries are sewn to a graft of donor's iliac artery, which is then sewn to the recipient's iliac artery.

3. The duodenum's new opening is sewn into the recipient's bladder that will eventually receive the exocrine pancreas secretions (enzymes).

Alternatively, the donor duodenum can be sewn to the recipient's intestine.  The first two attachments establish blood flow to the pancreas, allowing insulin release.  The third attachment allows the exocrine enzyme (amylase) to be excreted into the urine.  Low amylase excretion is a good marker of a pancreas graft rejection episode needing treatment, particularly in the absence of a same donor kidney graft (in which case an increase in blood creatinine is a good parameter).  The drainage into the bladder may lead to some post-transplant complications, in which case the recipient is reoperated and the same pancreas graft is attached to the intestine.

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Outcomes

Pancreas Transplant May Improve Quality of Life and Reverse Some Secondary Complications of Diabetes

A number of studies published in peer reviewed scientific journals have suggested that neuropathy, kidney disease, circulation, metabolism, and quality of life does improve following a pancreas transplant.  Dr. William Kennedy, a Professor in the Neurology Department at the University of Minnesota, showed that nerve conduction velocity and muscle action potential improved after a pancreas transplant.  Only half of people who have autonomic diabetic neuropathy survived five years, yet he showed that 85% of people who receive pancreas transplants are still living five years later. 

In a 1998 article in the New England Journal of Medicine, Dr. Michael Mauer from the University of Minnesota illustrated that a successful pancreas transplant reverses some of the secondary complications of diabetes.  He studied eight patients who received a pancreas transplant who has mild to advanced kidney lesions from nephropathy.  He did kidney biopsies before the transplant and 5 and 10 years after the transplant.  After 10 years, the kidney lesions had reversed.

Kidney Transplant vs. Pancreas Kidney Transplant

Most diabetic people who need a kidney transplant choose to also have a pancreas transplant.  Patients who have an organ transplant have to take immunosuppressive medications for life to keep their body from rejecting the new organ.  By having both a pancreas and kidney transplanted, patients prevent the recurrence of diabetic kidney disease.  Studies show that diabetic patients that receive both a pancreas and a kidney do better long-term than diabetic patients who receive a kidney transplant.  About 86% of recipients of kidney pancreas transplants studied were still alive eight years after transplant.  This compares with 47% of diabetic patients that received just a kidney transplant.

Preemptive Pancreas Transplant Alone

People who have diabetes are becoming increasingly aware of the long-term issues associated with this disease and are starting to think more proactively about the future of their health.  Dr. Mauer's work illustrated that people who are diabetic and have a predisposition for diabetic kidney disease may want to get a pancreas transplant alone before the deterioration of their kidneys becomes irreversible.  Currently, only about one-third of people who are on the waiting list for a kidney transplant will receive one.  Many of these people are on dialysis.  However, a person with diabetes who is on dialysis has less than a 50% chance of surviving for 2 years.  Few of these people survive for more than 5 years.

Living Donor Transplants Decrease Wait Times & Yield Better Outcomes

For pancreas transplants, the organs may originate either from a deceased-donor or living donor, or a combination of the two. It is not unusual for patients needing both a kidney and pancreas transplant to get the kidney transplant from a living donor, and then wait for a deceased-donor pancreas or have one simultaneously.  By doing so, these patients are reducing the risk associated with waiting for a kidney from a deceased donor; approximately 40% of people on the kidney waiting list nationwide die before they receive an organ.  In addition, transplant outcomes are generally better for people who have received a kidney from a living donor compared with one from a deceased donor.

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