The first pancreas transplant was in 1966. However, it was not until the 1990s that this kind of transplant was widely accepted by doctors.
What is a pancreas transplant for?
A pancreas transplant is necessary when the pancreas no longer produces insulin.
Having a pancreas transplant allows people with type 1 diabetes to maintain their blood sugar levels normally without receiving extra insulin or having to carry out the intensive monitoring typical of diabetes care.
There are three types of pancreas transplant:
- Pancreas transplant alone: This is performed on people who have type 1 diabetes but no kidney problems.
- Simultaneous kidney and pancreas transplant: This is done on a person who has type 1 diabetes and end-stage renal disease.
- Pancreas after kidney transplant: This is when a kidney transplant is performed first, from a living donor. The pancreas transplant from a deceased donor occurs later when an organ becomes available.
Who needs a pancreas transplant?
A pancreas transplant is an option for people with type 1 diabetes who cannot control their condition with insulin or oral diabetic medicine. The surgery is only appropriate for people with type 1 diabetes.
People with type 1 diabetes who might benefit from a pancreas transplant include those who:
- might regularly pass out
- have to regularly visit the emergency room because of their blood sugar level
- have uncontrolled average blood sugar levels
- need a caregiver to be present constantly in case of an emergency, despite using recommended medical therapies
In 2016, it was reported that a woman from the United Kingdom had become the first person in the world to receive a pancreas transplant because of a severe phobia of needles that left her unable to inject insulin.
The woman's phobia was so severe that she would shake uncontrollably and vomit when attempting to administer the insulin that she needed to control her type 1 diabetes.
Doctors were concerned about recommending a pancreas transplant because she did not meet the usual criteria. Eventually, however, it was judged she was a special case and a transplant was justified.
What to expect
Before a transplant is decided for a patient, a medical team will perform different tests as part of the evaluation process.
In the United States, there are about 1,200 people waiting for a pancreas transplant. Some 2,200 others are awaiting a combined kidney-pancreas transplant.
According to the National Kidney Foundation, the average waiting time for a simultaneous kidney and pancreas transplant is 3 years. According to Johns Hopkins, pancreas transplants alone or pancreas after kidney transplants typically have waiting times of more than 2 years.
Before they are matched to a donor, a person interested in having a pancreas transplant will be seen by a team of experts. This may include surgeons, endocrinologists, nephrologists, and social workers. These experts will make sure that a transplant is the right option for them.
There are several medical tests that a person will need to undergo as part of the evaluation process. Usually these will take 1-2 months.
Some people are able to access a pancreas transplant via Medicare.
A person needing a pancreas transplant has to be matched to a donor with the same blood type as them.
A test called a crossmatch is also used to compare the antibodies of the donor and recipient. This test helps determine whether the match is suitable.
During the transplant, a cut is made down the middle of the patient's upper body. During the operation, the surgical team will ensure that blood continues to flow into the arteries and digestive enzymes from the bowel flow out of the patient's system. The surgery takes around 4-6 hours.
Afterward, the patient is moved to the transplant unit and will remain in hospital to recover for about 2 weeks.
Risks of pancreas surgery
Infection is a risk in pancreas transplants as it is in all types of major surgery.
Swelling of the pancreas is common in the days following a transplant. This is known as pancreatitis.
Pancreatitis normally clears up after a few days. In some cases, however, it may be necessary for tubes to be inserted into the person's tummy to drain any excess fluid from the donor pancreas.
In the days following surgery, a person is also at risk of developing blood clots. These can stop the donor pancreas from working properly.
The risk of developing a blood clot can be reduced by taking blood-thinning medication. If a clot forms within the new pancreas, it may be necessary to have the clot removed with a further operation.
There is also the risk that the body might reject the donor pancreas. The immune system may attack the transplanted organ if it identifies it as a foreign body. Rejection can happen days, weeks, months, and sometimes years after the transplant has happened.
After a pancreas transplant, a painful or swollen tummy and vomiting may be signs that the pancreas is being rejected.
Symptoms that the donor pancreas is being rejected include the following:
- having a painful and swollen tummy
- chills and aches
- shortness of breath
- swollen ankles
A person who has received a pancreas transplant will need to take drugs called immunosuppressants for the rest of their lives. The immunosuppressants help to prevent their body rejecting the new pancreas.
Immunosuppressants can weaken the immune system and cause side effects. These side effects include:
- a susceptibility to infections
- shaky hands
- difficulty sleeping
- high blood pressure
- hair loss
- mood swings
- weight gain
- upset stomach
- weakened bones
Some people who take immunosuppressants may also be at increased risk of some types of cancer.
However, experts report that people that have undergone a pancreas transplant generally prefer taking these medicines to having to inject insulin and constantly monitor their blood sugar levels.
As a result, a successful pancreas transplant can improve the quality of life of someone who has type 1 diabetes.