Reviewed by Michael Fuller, MD
For people with type 1 diabetes, careful dietary management and a regular exercise program can be crucial strategies when it comes to preventing health complications down the line.
In type 1 diabetes, the pancreas produces little or no insulin, which is the hormone that makes it possible for the simple sugar called glucose to enter cells. While many diabetics are able to keep their insulin and blood sugar levels close to normal with carefully maintained lifestyle changes and insulin injections, these methods may not be enough. People who fit this description may be good candidates for pancreas transplant.
A pancreas transplant is a major surgical procedure that may cure diabetes if successful.
To be eligible for the procedure, a patient must be healthy enough to withstand major surgery and tolerate lifelong post-transplant medications, be free of medical conditions that would hinder the success of the transplant, and be willing and able to take medications as directed.
Once a patient is deemed a good candidate for a transplant, it is important to continue with all treatments and diabetes management methods and to keep all scheduled doctors appointments. Those awaiting a donor organ must remain available to their medical teams at all times, as the window for transplanting an organ may be only a few hours.
The surgery usually takes about three hours, though if a kidney transplant is also being performed (sometimes recommended for patients who are also experiencing diabetic kidney failure) the surgery will take several more hours.
To perform the surgery, the surgeon places the donor’s pancreas and a small portion of the small intestine into the patient’s lower abdomen. The surgeon then attaches the donor’s intestine to the patient’s small intestine, and connects the pancreas to blood vessels that supply the legs. The patient’s own pancreas will likely be left in place to aid digestion.
In a combined kidney-pancreas transplant, the new kidney will be attached to blood vessels in the lower part of the abdomen, and the tube that links the kidneys to the bladder (the ureter) will be connected to the patient’s bladder.
The new pancreas should begin working immediately, and the new kidney may begin working immediately or take as long as two weeks to function normally. The patient’s own pancreas will continue to perform metabolic functions other than insulin production.
Recovery from this surgery usually involves about a week in the hospital and three or four weeks of close monitoring after release. Pain and swelling is common around the incision sites.
Even in the case of a very close match between donor and recipient, the immune system will try to reject the new pancreas. In order to stop rejection from occurring, it is necessary to take a lifelong regimen of immune-suppressing drugs. The side effects of these drugs may include a rounded face, acne, development of facial hair, and abdominal problems. The increased vulnerability to infection that results from suppressing the immune system may require the use of antibiotic, antiviral and antifungal medications. Some medications may also increase the risk of high cholesterol, high blood pressure and cancer.
It is important to note that the side effects of pancreas transplant may be as serious as the symptoms of diabetes. The decision of whether to go through with this procedure will have serious consequences for patients and their families, and should be made in consultation with at least one experienced diabetes specialist who can explain the potential risks and benefits.
Last updated: 10-Dec-07