Alternate Names : Pancreatic Transplant, Transplantation of the Pancreas
In pancreas transplantation, a healthy pancreas is removed from a organ donor who is brain dead and implanted into a person whose own pancreas has failed. The recipient's failed pancreas is not removed. Pancreas transplantation is used to treat diabetes. In just about all cases, the diabetes is the form that affects children and young adults, known as type I diabetes. It is a long-term condition in which the pancreas is no longer able to produce insulin.
Persons with diabetes often have chronic renal failure as well as pancreas failure. Because of this, a person may be in need of a kidney transplant. There are three types of pancreas transplant operations:
combined kidney-pancreas transplant
"pancreas after kidney" transplant, in which the pancreas is transplanted some time after a kidney has been transplanted
pancreas transplant alone
Who is a candidate for the procedure?
Pancreas transplantation is only offered to persons with severe pancreatic failure. Individuals with type I diabetes ranging in age from a child to a 50 year old are possible candidates. Occasionally a person older than 50 may be considered for pancreas transplantation. However, many of them have had diabetes so long that other complications make pancreas transplant surgery too risky.
A person is evaluated by a team of healthcare professionals to see if he or she is a good candidate for a pancreas transplant. This team includes surgeons, kidney specialists known as nephrologists, social workers, nurses, and transplant coordinators. A few conditions would disqualify a person from receiving a pancreas transplant. These include:
cancer within the past five years
certain infections, such as tuberculosis or osteomyelitis, a bone infection
severe lung, liver, or kidney problems or complications from diabetes that would make the operation too risky
A candidate for a pancreas transplant needs to know that he or she will need to take medications to keep the body from "rejecting" the transplant. That is, the body's immune system would normally attack the new pancreas because it is something foreign. Immunosuppressants are medications that keep the immune system from attacking the new pancreas. These medications need to be taken for as long as the new pancreas functions. The person will also need lifelong follow-up by healthcare professionals.
If a person is found to be a good candidate for the transplant, the person's name is placed on a waiting list. It can sometimes take years for a recipient to receive a pancreas from a donor. There are currently about 3,000 people in the US waiting for a pancreas or a combined pancreas-kidney transplant.
How is the procedure performed?
Usually many organs (heart, lungs, kidneys, pancreas, and liver) are being removed from the brain dead donor. There may be two or three teams who operate on the donor at the same time. After the organs are removed, they are packed for transport to the recipient. The donor's chest and abdomen are sewn up and normal preparations for a funeral take place.
The pancreas can be preserved safely for about 12 to 15 hours. The transplant surgery needs to take place within this timeframe.
The pancreas transplant recipient is given general anesthesia. This means that the person is put to sleep with medications and feels no pain. The person is put on a ventilator, or artificial breathing machine, during the surgery. For a pancreas transplant alone or "pancreas after kidney" transplant, a curved incision is made in the lower part of the abdomen off to one side or the other. The pancreas can be placed on the left or the right side. If a kidney transplant has already been done, the pancreas is placed on the opposite side.
If a combined pancreas-kidney transplant is to be done, the pancreas is usually placed on the right side and the kidney on the left. The pancreas is usually implanted first, followed by the kidney.
There is a major artery and a major vein that need to be connected to the new pancreas. After that, blood flow is restored to the new pancreas. Then the duodenum, which is the beginning of the small intestine, from the donor pancreas is connected to the recipient's intestine or bladder. Once all of the connections are complete, the incision is closed and the recipient is taken to the intensive care unit for recovery.