What is the pancreas and why would a person need a transplant?

Why transplant a whole pancreas and not just the islet insulin producing cells?

Is a pancreas transplant suitable fore all people with diabetes?

Is a pancreas transplant a simple procedure?

Do I need to take medicines afterwards?

What are the risks?

What are the benefits of a pancreas transplant?

How successful is pancreas transplant?

How long will I be in the hospital?

What happens to my old pancreas?

Will I need to follow a diet for diabetes after the transplant?

What is the pancreas and why would a person need a transplant?
The pancreas is an organ situated inside the abdomen, close to the stomach. It secretes pancreatic juice that helps the body to digest the food we eat. It also secretes hormones into the blood. One of these hormones is insulin. Small clusters of cells within the pancreas called islets produce the insulin. When these cells are damaged, they don’t make insulin anymore. This causes type 1 diabetes. When the surgeon transplants a new pancreas into a a patient, it provides a new source of insulin. This means the patient no longer needs to inject insulin.

Why transplant a whole pancreas and not just the islet cells that produce insulin?
Although research has been conducted for many years into islet transplantation, success varies. Only about two percent of the pancreas is made up of islet cells. It is a difficult procedure to extract the cells to transplant them on their own. A few patients have received islet transplants, but the islets work better and for a longer time when a whole pancreas is transplanted.

Is a pancreas transplant suitable for all people with diabetes?
No.  A pancreas transplant is suitable only for people with type 1 diabetes -- people whose bodies do not make insulin. People with type 2 diabetes do still make insulin, but develop a resistance to it, so a pancreas transplant may not help. In addition, a transplant is normally restricted to patients who also need a kidney transplant.

Is it a simple procedure?
A pancreas is often transplanted after a living donor kidney transplant or at the same time as a kidney transplant. It is a more complicated procedure than a kidney transplant and takes much longer to perform. The operation itself involves connecting the blood supply of the pancreas to the vessels that take blood to and from the leg, usually the right leg. The leg normally gets much more blood than it needs and does not suffer from the operation. In addition to connecting the blood vessels, the surgeon also needs to connect the pancreas to a part of the bowel or bladder to drain the digestive juices that the new pancreas produces.  All this is done through an incision in the abdomen. 

Do I need to take any medicines afterwards?
Yes.  Like all transplants you need to take drugs called immunosuppressants.  However since you will be having a kidney transplant at the same time you will be having these drugs anyway.  What you won’t need again is insulin.

What are the risks?
Like all transplant operations there is the potential for problems.  In the case of pancreas transplants these problems include rejection of the pancreas, clotting of the blood supply, and inflammation of the pancreas (pancreatitis).  Rejection will happen in about a third of pancreas transplants, and clotting of the blood supply in about five in 100.  We are always monitoring you for these problems and you will be given treatment to avoid them or treat them.  In addition some patients, (about four in 10), will need a second operation to fix a problem that occurs early after the transplant.  It is true to say that problems in the early days are more common if you have both a kidney and pancreas than if you just have a kidney.  However you will be carefully assessed to make sure you are fit enough to withstand the procedures before your name is placed on the waiting list.

Pancreas transplantation is potentially dangerous, and therefore you will be carefully looked after.  Occasionally patients may die from combined pancreas and kidney transplantation, just as they may die after kidney transplant alone – but it is uncommon (less than five in 100). What a successful pancreas transplant would do is allow you to reduce the damage which diabetes causes so that your chances of being alive in the long term (10 years from now) are better if you have a pancreas and kidney than just a kidney alone.

What are the benefits of a pancreas transplant?
As well as not needing to give yourself insulin injections anymore you won’t need to worry about frequent blood sugar tests or diabetic diets.  The biggest benefit is that once you have a pancreas transplant, and your insulin is controlled automatically, most of the other damage that diabetes does to you is stopped.  In some cases some of the problems may improve, although it usually takes several years to see any improvement.  This includes problems with nerve damage and heart disease.  The pancreas will also stop you damaging your new kidney in the same way your diabetes damaged your own kidneys.

How successful is pancreas transplant?
A kidney transplant in a diabetic patient is very successful, with over 85% working one year after, and with an average life of 8 to 10 years.  Results of a pancreas transplant are also good, with over 75% working at a year and lasting an average of 8 years.  Because of its improved success it is now the recommended treatment for patients with diabetes and kidney failure.  Nevertheless occasionally it isn’t successful and the pancreas may need to be removed (10% of patients in the first year).

How long will I be in hospital?
For a either a pancreas transplant alone, or a kidney/pancreas transplant, patients normally stay for seven to 10 days. 

What happens to my old pancreas?
We do not touch your own kidneys or pancreas – they are left alone.  Your own pancreas continues to work producing digestive juices.

Will I need to stay on a diet for diabetes after the transplant?
You will not need to follow a diabetic diet, or a renal diet.  We would ask that you avoid putting on a lot of weight.