Pancreas transplant

Overview: 

A Pancreas transplant is a surgical procedure where a diseased pancreas is replaced with a healthy one. The healthy pancreas is taken from a deceased donor and replaced in a living person. Most of the transplantations are done in individuals with type 1 diabetes who do not have proper glycemic control. Transplantation of the pancreas in such diseased individuals decreases the risk of life-threatening conditions and increases the survival rate and quality of life. 

Pancreas: 

The pancreas is a vital body organ that regulates blood sugar levels. It has an exocrine and endocrine part. The exocrine part helps in food digestion and the endocrine part helps in blood sugar regulation by secreting hormones. The pancreas secretes a hormone called insulin which takes part in blood sugar control. Improper secretion of insulin due to damage to certain tissues of the pancreas leads to the development of type 1 diabetes. Hence a pancreatic transplant has to be done to treat uncontrolled pancreatic disorders. 

Indications: 

Uncontrolled Type 1 diabetes mellitus is the main indication of pancreatic transplant. This is because of the damage to the tissues of the pancreas that secrete the insulin that helps in blood sugar control. Uncontrolled type 2 diabetes is rarely indicated for pancreatic transplant as the main cause in type 2 diabetes develops due to insulin resistance and the inability of the body tissues but not improper production of insulin. 

Other indications for pancreatic transplant include pancreatic cancers, frequent insulin reactions, severely damaged kidneys, type 2 diabetes with low insulin resistance and production, and constantly poor blood sugar control. 

Contraindications: 

Pancreatic transplant is a complex surgery as it can cause severe side effects due to medications. Hence, it is contraindicated in the following: 

• Individuals who are more than 65 years of age, 
• With life-threatening cardiovascular diseases, 
• Recent history of heart attack
• Advanced cancers except skin cancer
• Low-grade prostate cancer, 
• Active infection
• Immunosuppressive condition
• Peptic ulcer disease
• Psychiatric disorders of long-duration
• Body mass index > 30kg/m
• Insulin requirements of >1.5 units/kg/day 
• Long-standing cerebrovascular disease 
• Active hepatitis infections 
• Continuous alcohol or drug abuse 

Types of Pancreatic transplants: 

Pancreatic transplantation is done in various ways. They are:

• Pancreatic transplant alone (PTA) is a PT done in diabetics with only pancreatic damage and no kidney disease. 
• Simultaneous Pancreas and kidney transplant (SPK) is done in diabetics with pancreatic damage along with kidney disease due to diabetes. 
• Pancreas after kidney transplant (PAK) is done in diabetics who need both pancreatic and kidney transplants. But if a kidney donor is available first, then a kidney transplant is carried on. 
• Simultaneous deceased pancreatic donor and live kidney donor are done in individuals simultaneously when both donors are available. 
• Pancreatic islet cell transplant is done in individuals where the donor's pancreatic islet cells are injected into the vein of the recipient. 

Before the procedure: 

A pancreatic transplant is done in a transplant center. Before the transplant, the individual is evaluated for the surgery by some blood tests, physical examinations, imaging studies, psychological evaluation, and any other necessary tests. The entire history regarding previous illnesses, surgeries, medicines taken, and allergies should be informed to the concerned healthcare professional. 

Based on the test results and evaluation one will be informed if they can be taken for a pancreatic transplant. Sometimes certain medications need to be stopped like blood thinners, and over-the-counter medications. Other medications may be prescribed before surgery. Dietary modifications will be made before surgery.

Matching a donor for transplantation is also very important for a pancreatic transplant. Individuals will be kept on the waiting list for deceased donors for pancreatic transplantation. Donors will also be evaluated and subjected to certain tests to check for compatibility. If both pancreas and kidneys are being transplanted simultaneously, they will be evaluated for both conditions. 

These tests include blood typing (to check if the blood groups of donor and recipient are suitable), tissue typing (to check if the transplanted tissue will last for a long time in the recipient's body), crossmatch (to check if antibodies of the recipient will reject the donor tissue). 

An individual has to be active and healthy for a successful pancreatic transplant. Taking the prescribed medications on time, diet, regular exercise, and relaxing can keep one healthy and fasten the recovery after surgery. 

During the procedure: 

Pancreatic transplantation is done under general anesthesia. Making a small cut in the abdomen, the prepared donor pancreas is placed along with a part of the small intestine in the recipient's abdomen. Both the donor’s and the recipient’s intestines are connected by blood vessels. The recipient pancreas may be left to help in digestion or removed. If a simultaneous kidney transplant is done, then the ureters and the blood vessels are also attached. This surgery takes about 3-6 hours. 

After the procedure:

An individual is continuously monitored till the vitals stabilize and is awake. Medications are given that will prevent rejection of the donor's pancreas and reduce infection in the body. After being monitored for a few days, the individual is discharged from the hospital as the condition improves. Regular follow-up visits are done for 3-4 weeks. Immunosuppressant drugs that reduce the pancreatic rejections are prescribed. 

The success of Pancreatic transplant: 

Pancreatic transplantation is considered successful when the donor pancreas starts working and there is no necessity to use medications for diabetes. Regular exercise and physical activity help the individual to improve overall health. Maintaining a proper diet by consuming a lot of fruits, vegetables, enough fiber, whole-grain foods, poultry, and fish can keep an individual healthy. 

Risks and complications: 

Pancreas transplant carries significant risks and complications. They include bleeding, infections, blood clots, metabolic problems like excess body sugars, urinary complications, failure of the donated pancreas, or the rejection of the donor by the recipient. The immunosuppressant medications prescribed also can carry significant risks like decreased bone density, increased blood pressure and cholesterol levels, weight gain, puffiness, excess hair growth, swollen gums, and sensitivity to light. 

Conclusion: 

Pancreatic transplant is a complex surgical procedure that is done in uncontrolled-type diabetics. It can be done alone or in combination with a kidney transplant that may be damaged due to diabetes. Despite the risks, it can increase the chance of survival and improve the quality of life in transplanted individuals. 

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