Pancreas Transplant

The pancreas is an organ that resides behind the stomach and produces enzymes mainly involved in the digestion of food, especially proteins. These enzymes also help in the production of the hormone insulin, which helps maintain blood sugar levels. Pancreas transplant is a surgical technique that, today, is a new ray of hope for patients suffering from type 1 diabetes mellitus. Although insulin therapy with lifestyle changes has served as a cornerstone for type 1 diabetes management, few patients may experience complications, such as kidney failure, nerve damage, or severe hypoglycaemia for which conventional therapies are of no use. For these patients, pancreas transplant offers a potential source of insulin independence, thereby improving their quality of life. Just like all transplant procedures, pancreas transplants aren’t devoid of any risks, but recent advancements in immunosuppressive treatments and improved post-operative care offer a viable solution to these issues.

What is a pancreas transplant?

A pancreas transplant is a surgical procedure where a failing pancreas of the recipient is replaced with a healthy pancreas from a diseased donor. The pancreas is a vital organ for digestion and is situated behind the stomach. It also produces insulin, which is essential for glycaemic control. Type 1 diabetes is one such disease where the body’s immune system attacks the insulin-producing cells of the pancreas, leading to chronic insulin deficiency. The new, healthy, transplanted pancreas can effectively produce insulin, thereby eliminating the need for insulin injections.

Pancreas transplant surgery is of three major types:

1.    Pancreatic transplant alone:

This surgical procedure involves transplanting a healthy pancreas from a deceased donor who then can independently produce insulin. The transplanted pancreas is attached to the recipient’s blood vessels and intestine. This is the preferred surgical technique of choice for patients who do not have kidney failure but have severe diabetes-related complications. 

2.    Simultaneous pancreas and kidney transplant: 

This is a major surgical procedure wherein both kidney and pancreas are transplanted from a deceased donor to a recipient who has kidney failure secondary to type 1 diabetes mellitus. Most often, both kidney and pancreas are transplanted from a single donor. 

3.    Pancreas after kidney transplant: 

This surgical procedure involves transplanting the pancreas into a diabetic individual who already has a functional transplanted kidney.
In all the above procedures, the native pancreas is not excised but is kept in place to perform its routine digestive functions.

Who requires a pancreas transplant?

Not everyone with diabetes mellitus will necessitate a pancreas transplant. Pancreas transplant is ideally reserved for individuals with type 1 diabetes mellitus. Factors that need to be taken into account while determining eligibility for a transplant are as follows: 

1. Uncontrolled blood glucose levels: Patients warranting a pancreatic transplant often face difficulty in controlling blood sugar levels, even with intensive insulin therapy. These patients may experience recurrent episodes of hypoglycaemia, which can be life-threatening. 
2. Hypoglycaemia unawareness: At times, some patients may develop a condition called hypoglycaemia unawareness, where it becomes quite difficult to determine if the blood sugar content has reached considerably low levels. Such conditions increase the dangers of unconsciousness, seizures, and even death.
3. Severe diabetes-related complications: Many candidates for a pancreas transplant have secondary complications of diabetes, particularly diabetic nephropathy (kidney failure), neuropathy (nerve damage) and retinopathy (damage to retina). Candidates with renal failure are often the most likely to be given consideration for a simultaneous pancreas-kidney transplant.
4. End-stage renal disease due to diabetic nephropathy: For such cases, simultaneous pancreas-kidney transplant and pancreas after kidney transplant surgery are preferred. 
5. Insulin resistance or insulin intolerance: Occasionally, the patient will develop a resistance to insulin or will suffer severe side effects from the insulin therapy. In those cases, a pancreas transplant may be offered if the other treatments are inappropriate or will not control the diabetes.
6. Type 2 diabetes mellitus (Rare): In very few instances, patients with type 2 diabetes with extreme insulin resistance, on insulin therapy, and possessing other criteria become candidates for a pancreas transplant. These are less common because most type 2 diabetes patients continue to produce some amount of insulin and have other underlying metabolic disturbances that make the success of a pancreas transplant less predictable.

Benefits of pancreas transplant

The most significant advantages for patients looking to undergo a pancreas transplant are as follows:

1. Insulin independence: The most immediate benefit of a pancreas transplant is normalising blood glucose regulation within one’s body. This ensures freedom from years or decades of daily blood sugar monitoring. Potentially, an actively functioning pancreas facilitates blood sugar regulation through injections and/or pumps, making life much more akin to normal for those afflicted.
2. Prevention of diabetes-associated complications: Complications of diabetes may arise in the long term, ranging from failure of the kidney, cardiovascular disease, nerve damage, and eye problems. Normalisation of blood sugar levels will prevent or delay complications such as those stated above. In particular, a patient who undergoes a simultaneous pancreas-kidney transplant is likely to have improved kidney functions and lower risks of going on dialysis or further kidney damage.
3. Quality of life: Many patients with severe diabetes develop anxiety, depression, and a reduced quality of life as a result of constant monitoring and managing their condition. Pancreas transplantation can greatly relieve all the burden, and the patient can lead a more active and meaningful life free from hypoglycaemic episodes or diabetic complications.
4. Reduced risk of hypoglycaemia: Hypoglycaemia unawareness is one of the predominant problems in an advanced diabetes patient. Many patients who have successfully had a pancreas transplant are no longer capable of experiencing hypoglycaemia because their blood glucose level remains stable from the new pancreas without the usage of exogenous insulin.

How does team Fortis help in preparing for a pancreas transplant? 

Fortis Hospital is renowned for its advanced medical care and being a pioneer in organ transplantation. It provides comprehensive support throughout the process. Fortis lays its helping hand in various ways, from baseline evaluation to post-operative care. They include: 

1.    Pre-transplant evaluation: 

a.    Medical review: This includes an overall health review, including diabetes status, previous insulin therapy, and overall health. 
b.    Physical examination: This includes a detailed physical examination to ensure fitness prior to surgery. 
c.    Diagnostics: This includes blood tests, imaging such as a CT or an MRI scan, especially if the patient is undergoing a simultaneous transplant of both the pancreas and the kidney, and cardiovascular assessments to ensure that your heart is robust enough for surgery.
 

2.    Interdisciplinary approach: 

Fortis Hospital has a team of transplant surgeons, cardiologists, nephrologists, endocrinologists, anaesthesiologists, dieticians, and psychologists. This ensures you are prepared both physically and mentally for the transplant. With multiple specialists being involved, your care is comprehensive, addressing all specific needs.
 

3.    Patient education and counselling: 

Healthcare professionals at Fortis explain the transplant process so as to be well aware of the risks and benefits as well as what to expect. You will also be prepared with all pre-operative preparation, surgery, post-operative care, and lifestyle changes after the transplant.
Psychological counselling helps you deal with the psychological and emotional anxiety of waiting for a transplant and the further demand that you take care of yourself post-surgery. Such counselling may also be extended to your family in order to ensure that you have the appropriate support system.
 

4.    Preparation for immunosuppressive therapies: 

Immunosuppressants are vital for every organ transplant in order to prevent graft rejection. At Fortis Hospital, complete counselling is given to patients and their families on dosage and possible side effects of the administered immunosuppressive therapy. 
 

5.    Nutritional support: 
 

Fortis provides you with nutritional counselling so that your health improves and you become nutritionally fit for the transplant. This would come in handy because the body should be in the best shape possible to heal from the surgery. Nutritionists at Fortis ensure that the diabetes is managed with a tailored diet plan to maintain stable blood sugar levels before the surgery.
 

6.    Donor matching support and organ availability: 
 

Fortis is well endowed with an outstanding organ transplantation program and works in conjunction with national and international organ donation networks to ensure that you can obtain a suitable donor. The transplant team will assist in the listing process for deceased donor organs and bring you information regarding the criteria as well as the waiting time for a pancreas transplant.
 

7.    Post-operative monitoring and follow-up: 
 

Close monitoring will be done for weeks and months immediately post-transplant. Patients would be advised to have regular routine check-ups to monitor for current health status and to check for any signs and symptoms of rejection.

Road to recovery after pancreas transplant with team Fortis

The way to recovery after a pancreas transplant has, at Fortis Hospital, been etched out in the most comprehensive, patient-friendly way possible to ensure that every patient gets the very best. It includes: 
 

1.    Immediate post-surgery care: 
 

In the initial 24–48 hours following pancreas transplantation, patients are usually transferred to the intensive care unit for monitoring. Fortis Hospital provides care by a multidisciplinary transplant team comprising transplant surgeons, endocrinologists, nephrologists, and critical care specialists. Patients are continuously monitored to detect complications such as infection, bleeding, and organ rejection.
In this important stage, the team at Fortis decides whether or not the transplanted pancreas is active by doing follow-ups about insulin levels and glucose regulation. Patients are gradually shifted from the ICU to the general ward as their condition improves.
 

2.    Preventing organ rejection: 
 

A major challenge following pancreas transplantation is organ rejection. To prevent organ rejection, the patient is prescribed immunosuppressants, and the newly transplanted pancreas is taught by the body to accept. Extensive counselling and education on these medications, dosages, schedules, and potential side effects would be provided by Fortis Hospital. 
 

3.    Monitoring and follow-up care: 
 

Regular follow-up visits will be required for a proper recovery. Fortis Hospital ensures that patients undergo routine monitoring through blood tests, imaging, and kidney function studies to ensure the normal functioning of the transplanted organ. The frequency of follow-ups after the surgery is relatively higher in the initial period and gradually reduces over time. The transplant team of the hospital collaborates with each patient to monitor progress, alter medications, and treat complications if they develop.
 

4.    Lifestyle support: 
 

This period of post-pancreas transplantation involves major lifestyle modifications to prevent complications and ensure good health. Fortis offers personal consultations on diet, exercise, and diabetes care to help people adopt a healthy, balanced lifestyle. This will include designed dietary plans aimed at maintaining blood sugar levels and minimising chances of infection.

Conclusion

Pancreas transplant is commonly done to restore insulin production in patients with severe type 1 diabetes or those with certain forms of type 2 diabetes complicated by critical diseases. Such a procedure highly favours the outcome, providing strong control over blood sugar levels, allowing patients to discontinue their insulin therapy, and lessening the risk that complications secondary to diabetes pose for their lives, all factors that can help improve a patient’s quality of life. Successful results will be well tied to pre-operative assessments and post-operative treatment, such as immunosuppression to avoid rejection of the transplanted organs. Patients will receive counselling and support for lifestyle changes, nutrition, and healing. Monitoring the function of the transplanted organ post-surgery is crucial for long-term success. A pancreas transplant will improve the health and well-being of the patient if properly cared for and managed.