The pancreas, located below your liver and under your stomach, is about seven inches long and weighs about 3.5 ounces. It has two main functions. The first is to help digest food by making and releasing enzymes in the upper portion of the small intestine. Carbohydrates, fats and proteins are broken down into small parts that the body uses as nourishment. In addition, the pancreas makes large amounts of sodium bicarbonate, which can make the contents of the stomach less caustic or acidic as they flow through the small intestine. Sodium bicarbonate also helps keep fluids in the body and prevent dehydration.
The other job of the pancreas is to make insulin, a hormone necessary for the body to use carbohydrates properly. If you don’t produce insulin, you have a disease called diabetes.
A pancreas transplant can help manage the organ damage that may result from insulin-dependent diabetes. A successful pancreas transplant will eliminate the need for insulin injections, reduce or eliminate dietary and activity restrictions due to diabetes, and decrease or eliminate the risk of severe low blood sugar reactions.
The prognosis after pancreas transplantation is very good. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional.
Patients with type 1 diabetes may be evaluated for pancreas and kidney-pancreas transplants. Patients with type 2 diabetes are less likely to be candidates for a pancreas transplant because they may be insulin-resistant and unable to reap the benefits of a pancreas transplant.
One of the most serious complications of type 1 diabetes is end-stage renal disease (ESRD) or end-stage kidney disease, which may require a kidney transplant. A kidney transplant without a pancreas transplant means you must take antirejection medication for the kidney and continue to take insulin.
The possibility of diabetes damaging the new kidney and other organs also remains. Successful combined kidney-pancreas transplants prevent diabetic damage in newly transplanted kidneys as well as eliminate the need for insulin therapy. In the best case scenario, a patient would receive a new kidney and pancreas from the same donor.
For the evaluation for a pancreas transplant, you will undergo a number of tests. Some of them are:
- Blood tests, including an HIV (AIDS) test, within the last year.
- Chest X-ray within the last year.
- Creatinine clearance testing for those not on dialysis. This test, conducted over a 24-hour period, compares how much creatinine a blood waste product occurs in the blood and in the urine to evaluate kidney function.
- Echocardiogram within the last two years. This test uses sound to create a picture of heart function.
- Electrocardiogram (EKG or ECG) within the last year.
- Persantine thallium or comparable test within the last two years. This test involves intravenous application of persantine to help expand the arteries and replicate the effect of vigorous exercise, and of thallium, a radioactive isotope detected by X-ray.
- Stool guaiac, which is a test for blood in stools.
- Tuberculosis (TB) skin test.
Other tests may be required — depending on your gender, age and medical history — such as a colonoscopy, mammogram, Pap smear or prostate specific antigen (PSA) test. Additional testing may be ordered, based on results of these tests.
Patients who undergo pancreas transplant, also must have a designated caregiver for assistance after the surgery. This person is needed to help bring you to clinic appointments and help you at home during the first days after leaving the hospital.
Because there’s a shortage of donor pancreases, patients must wait for an available organ. These wait periods vary depending on blood type. In general, pancreas and kidney-pancreas wait times are shorter than the wait times for a kidney alone.
Kidneys and pancreases may be provided by a cadaveric donor, or a person who is brain dead. Kidneys also may be provided by a living donor who donates one of his or her kidneys and survives on the remaining kidney. While live kidney donors don’t have to be blood relatives, they must have a compatible blood type. Donors may be excluded for high blood pressure, obesity, diabetes or history of cancer.
Complications immediately after surgery include:
- Thrombosis
- Pancreatitis
- Infection
- Bleeding
- Rejection
Rejection may occur immediately or at any time during the patient’s life. This is because the recipient’s immune system considers the new organ as foreign object and will try to combat it. Organ rejection is a serious condition and ought to be treated immediately. To prevent rejection, patients must take powerful anti-rejection medications for the rest of their lives. These medications have many side effects and makes patients more susceptible to other illnesses, including cancer.
Pancreatic Islet Transplant
Clusters of cells, called the islets of Langerhans, are spread throughout the pancreas. Islets are made up of two types of cells — the alpha cells, which make glucagon, a hormone that raises the level of glucose or sugar in the blood and the beta cells, which make insulin.
In a minimally invasive procedure, insulin-producing beta cells are isolated from a donor pancreas, then injected through the skin into the portal vein of the liver, where they attach to new blood vessels and release insulin. For an average-size person, a typical islet transplant requires about one million islets, equal to two donor organs.