A pancreas transplant is a surgical procedure during which a healthy pancreas from another person is placed inside and connected to a patient whose pancreas is not working properly. This operation usually is performed to treat people with type 1 diabetes, but it can also be helpful for some patients with type 2 diabetes.
Diabetes and the Pancreas
Understanding diabetes begins with the pancreas, an organ located in the mid and left upper abdomen near the stomach, first portion of the small intestine and spleen. It contains several types of cells with distinctly different functions. The cells of the exocrine pancreas make digestive enzymes that help to break down carbohydrates, proteins and fats in the diet. These enzymes are released into the first portion of the small intestine. The cells of the endocrine pancreas (located in the pancreas in small groups called islets) make hormones like insulin and glucagon. These hormones help the body to regulate and utilize glucose (sugar).
In patients with diabetes, the body is unable to make or use the insulin, resulting in high blood glucose levels. Type 1 diabetes occurs when the body’s immune system attacks the islet cells in the pancreas that produce insulin. Over time, all of the islet cells are lost, so the pancreas no longer makes any insulin. Type 1 diabetes is treated with insulin injections. Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body’s cells become less sensitive to insulin (called insulin resistance). It is more common than type 1 diabetes. Inactivity, poor diet and excess body weight all increase your risk for type 2 diabetes. Some patients with type 2 diabetes get better when these risk factors are addressed. Others require oral medications or insulin injections to control their blood sugars.
About Pancreas and Kidney-Pancreas Transplants
During a pancreas transplant, surgeons connect the donor pancreas to blood vessels so that the transplanted pancreas can release insulin into the patient’s blood stream. They also connect a small segment of the donor’s small bowel (which is attached to the donor pancreas) to the recipient’s small intestine to allow the digestive enzymes manufactured by the new pancreas to be released.
A pancreas transplant often is performed along with a kidney transplant. This operation is called a simultaneous kidney and pancreas transplant and is performed for patients whose kidneys have stopped working, usually because of diabetes. The kidneys cleanse the blood of impurities; control fluid volume in your body; and produce a hormone that stimulates red blood cell production. A kidney transplant places a healthy donor kidney in the patient and connects it to the recipient’s blood vessels so that the donor kidney can perform these tasks.
A pancreas transplant also can be performed as a second surgery after a kidney transplant. This procedure is called a pancreas-after-kidney transplant. This kind of transplant often is used to treat patients with diabetes who already have received a kidney transplant from a living donor.
Sometimes, a person without kidney failure receives a pancreas transplant. This procedure is called pancreas transplant alone. It usually is reserved for patients with difficult-to-control diabetes, particularly those who have frequent complications from low blood sugar. In some cases, patients may not have any symptoms of low blood sugar even when their levels are dangerously low. Pancreas transplantation can be very helpful for these patients because it may eliminate the need for insulin injections and allow the body to resume regulating blood sugars.
Many patients choose transplantation to improve quality of life and to have a more independent lifestyle. If a pancreas transplant is successful, the patient may no longer need insulin shots, should be able to eat a regular diet and also should have fewer problems with low or high blood sugar levels.
However, transplant is not a cure and is not the best option for everyone. Transplant comes with risks, including failure or rejection of the donated organ(s), blood clots, infection and a number of possible side effects of the medications patients must take to prevent the body’s immune system from rejecting the transplanted organ(s). The Rush Pancreas Transplant Care Team evaluates each patient to determine if transplant is the best option.
Pancreas and Kidney-Pancreas Transplantation at Rush
The University Transplant Program at Rush offers simultaneous kidney-pancreas transplants, pancreas-after-kidney transplants and pancreas transplant alone. Simultaneous kidney-pancreas transplantation is an option for patients who are experiencing kidney failure due to their diabetes. Pancreas-after-kidney transplantation is an option for diabetic patients who already received a successful kidney transplant (from either a living or deceased donor) and have stable kidney function. All pancreas transplants use a pancreas from a deceased donor who registered to be an organ donor while still living or whose family gave consent to organ donation.
At Rush, both procedures take place in the following five steps: