A pancreas transplant is surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to stop taking insulin injections.
Transplant - pancreas; Transplantation - pancreas
The healthy pancreas is taken from a donor who is brain dead, but is still on life support. The donor pancreas must be carefully matched to the patient who is receiving it.
A portion of the first part of the small intestine, called the duodenum, is transplanted with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.
The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the patient's abdomen. Blood vessels from the new pancreas are attached to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder.
The surgery for a pancreas transplant takes about 3 hours. However, the operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease. The combined operation takes about 6 hours.
Why the Procedure Is Performed
The pancreas makes a substance called insulin. Insulin moves glucose, which is sugar, from the blood into the muscles, fat, and liver cells, where it can be used as fuel.
In people with type 1 diabetes, the pancreas doens't make enough, or sometimes any, insulin. This causes glucose to build up in the blood, leading to high blood-sugar levels. High blood sugar levels can cause many complications, including:
A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved with surgery, however, most people with type 1 diabetes do not have a pancreas transplant soon after they are diagnosed.
A pancreas transplant is major surgery, and people with diabetes have a high-than-normal risk of heart disease and other complications.
People who have had a pancreas transplant will need to take several medicines for the rest of their lives. These medicines have serious side effects.
Because of these risks, pancreas transplant is rarely done alone. It is almost always done when someone with type 1 diabetes also needs a kidney transplant.
Pancreas transplant surgery may NOT be done in patients who also have:
A history of cancer
Infections such as hepatitis, which are considered to be active
Leakage of fluid from the new pancreas where it attaches to the intestine or bladder
The body's immune system considers the transplanted organ foreign, and fights it. To prevent rejection, organ transplant patients must take drugs (such as cyclosporine and corticosteroids) that weaken the body's immune response. This makes the person less able to fight infections and can cause other medical problems.
Before the Procedure
Patients who have a pancreas transplant have chronic kidney disease along with their diabetes. Because of this, they will have the following tests before the transplant:
Blood work to look at liver and kidney function
Blood and urine tests to make sure there is no infection (such as HIV, hepatitis, or CMV)
Lipshutz GS, Wilkinson AH. Pancreas-kidney and pancreas transplantation for the treatment of diabetes mellitus. Endocrinol Metab Clin North Am. 2007;36(4).
White SA, Shaw JA, Sutherland DE. Pancreas transplantation. Lancet. 2009; 373(9677):1808-1817.
Markmann FJ, Yeh H, Naji A, et al. Transplantation of abdominal organs. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 28.
Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.