The Pancreas Transplant Program at Rush was developed as an extension of the already established liver, kidney and small bowel transplant programs. It has been active since 1994.

The program was designed as a multispecialty group with input from transplant surgeons, nephrologists, endocrinologists and other medical and surgical specialists. A protocol for pancreas transplant was developed prior to the first pancreas transplant being performed. This protocol continues to be refined by the Pancreas Transplant Committee.

The director of the Pancreas Transplant Program is Deepak Mital, MD, assistant professor of surgery in the Section of Transplant Surgery. Dr. Mital received training in pancreas transplant surgery at Albert Einstein Medical Center in Philadelphia. He also has several years of experience in kidney and liver transplantation, critical care and immunobiology.

David Baldwin, Jr., MD, associate professor of medicine in the Section of Endocrinology is the Pancreas Transplant Program's endocrinologist. Dr. Baldwin's appointment brings with it the needed years of expertise only a clinical endocrinologist and diabetes research could bring.

The deleterious effects of Type I diabetes on renal function are well known. To address these problems, Janis Orlowski, MD, associate professor in the Section of Nephrology joined the team. Dr. Orlowski was instrumental in established the Pancreas Transplantation Evaluation Committee, which is comprised of the transplant surgeon, transplant endocrinologist, transplant nephrologist, and specialists in ophthalmology, orthopedics and podiatry. The committee also includes representatives from social work, nursing staff, behavioral science and hospital administration. Members of the team work together—reviewing patient histories and laboratory data—to evaluate and select the appropriate candidates for transplant.

The program has adhered to strict standards of patient and donor selection. This has resulted in patient survival as well as renal and pancreas graft survival rates that far exceed the national average.

Bicarbonate loss following bladder drainage of the pancreas allograft can have a negative impact on patients’ quality of life following transplant. We have modified the technique of drainage into the bowel, resulting in a markedly reduced bicarbonate loss and subsequent improved post-transplant management.

We have reviewed the factors that significantly contribute to the cost of pancreas transplantation. From this review, we found the use of anti-lymphocyte globulin was a significant factor in raising costs. The Rush program currently is not using anti-lymphocyte globulin for induction without a demonstrable alteration in graft survival.

The three most common postoperative complications and reasons for readmission have been identified as 1) dehydration, 2) CMV infection and 3) urinary tract infection. Prophylaxis by the use of hydration at home and viral/bacterial suppressive therapy has recently been applied to reduce these complications.

The program at Rush serves the minority population well above the national rate. Rush's pancreas transplant patients have been 51 percent Caucasian, compared to 91 percent for the country as a whole. African-American patients account for 27 percent of Rush's pancreas transplant patients, whereas they account for only 4.9 percent of pancreas transplant patients nationwide. Hispanic patients make up 22 percent of Rush's patient population in pancreas transplantation, compared to a national rate of only 2.3 percent.