Familiarity with pancreas transplantation
The pancreas is an organ inside the abdomen that helps digest food and regulate blood sugar.
Pancreas transplantation was first performed in 1967 in Minneapolis, Minnesota. The main use of this transplant is in diabetic patients who also have kidney failure. In these patients, either the pancreas and the kidney can be transplanted simultaneously (during one operation) or the pancreas can be transplanted after the kidney transplant (during two surgeries several months or several years apart).
Pancreas transplantation is rarely performed alone. Sometimes in a diabetic patient, controlling blood sugar is associated with many difficulties for the patient or the patient suffers from severe and dangerous hypoglycemia due to insulin treatment. In these patients, pancreas transplantation can be performed alone.
Pancreas transplantation is mainly used in patients with type 1 diabetes or insulin-dependent diabetes. Rarely, pancreas transplantation can also be used in type 2 diabetes or non-insulin dependent diabetes.
Pancreas transplantation improves the quality of life of patients and even increases their life expectancy by treating diabetes.
In a pancreas transplant, the entire pancreas is transplanted to the patient, so this organ should only be obtained from a donor with brain death. In the past, a live donor was used for this transplant, but due to the risk of the donor developing diabetes, this method is obsolete today.
There are two things to keep in mind when it comes to pancreas transplantation:
First: Because pancreatic blood supply is shared with the first part of the small intestine called the duodenum, this part of the intestine also connects with the pancreas. So this transplant is actually a pancreatic and duodenal transplant.
Second: With whole pancreas transplantation, another function related to digestion is also available to the patient, while the patient does not need this function and the main reason for transplantation is the function of this organ in regulating blood sugar.
These two points sometimes lead to the complications of this connection. Due to the need to sew twelve to the recipient, sometimes there is a leak of pancreatic juice, which is for digestion.
Pancreas transplantation is associated with certain complexities and delicacies. The pancreas, like the kidneys in the pelvis, can be attached to the arteries of the lower extremities or placed in the abdomen. However, the patient’s pancreas itself is not manipulated and remains in place.
Pancreas transplantation has several major benefits: First, it treats diabetes and eliminates the need for insulin injections, thus increasing patients’ quality of life. Second, pancreatic transplantation has been shown to have a positive effect on the secondary complications of diabetes. These include cardiovascular disease, atherosclerosis, retinal disease, and neurological complications associated with diabetes.
In pancreas transplantation, like kidney transplantation, the compatibility of the donor and recipient blood groups is a basic condition.
Due to the complexities of this type of transplant, the medical team must monitor the patient with full knowledge of them. The patient should take anti-transplant drugs that weaken the immune system for the rest of his life. These drugs reduce the risk of transplant rejection well, but also increase the risk of infections. Therefore, the transplant team must carefully examine the patient in this regard. The patient should inform the transplant team immediately if any abnormal symptoms occur. Despite these problems, pancreas transplantation is currently associated with a high success rate.
Dr. Reza Saidi Firoozabadi – Transplant surgeon
Another article on pancreas transplantation
The pancreas is an organ in the abdomen that performs a variety of functions, including regulating blood sugar (by secreting insulin) and aiding digestion by secreting certain pancreatic juices. There are many issues before and after a pancreas transplant. Prior to transplantation, the transplant team carefully evaluates the patient. These transplants will also be available after the transplant to ensure the new pancreas is functioning and the patient is healthy.
The body’s inability to produce or consume insulin causes diabetes. Insulin causes sugar to enter cells and convert it into energy. When the body is unable to produce insulin, blood sugar cannot enter the body’s cells and accumulates in the blood. This causes two problems: first, the body’s cells cannot use sugar as an energy source, and second, high blood sugar damages the eyes, kidneys, nerves, and heart.
Diabetes occurs in two ways:
In type 1 diabetes, the pancreas loses its ability to produce insulin. In type 2, the body has enough insulin but has lost the ability to use it.
Pancreas transplantation and treatment of diabetes
Pancreas transplantation is useful in patients with type 1 and sometimes type 2 diabetes. Pancreas transplantation has several advantages:
1- The patient will not need insulin injection,
2- The patient can have a normal diet (not a special diet for diabetics),
3- The patient will have normal blood sugar and blood sugar will not go up and down,
4 – The patient can live actively and independently of others so that his quality of life will be much better and high blood sugar will not damage the kidneys and other organs.
5 – Pancreas transplant will prevent the progression of diabetes complications such as damage to the eyes, heart, arteries and nerves.
Pancreas transplantation is performed in 3 ways:
1- Simultaneous transplantation of pancreas and kidney: This condition is for patients who also have kidney failure due to diabetes. In this condition, the kidney and pancreas are removed from a brain-dead donor and both organs are transplanted during surgery.
2- Pancreas transplant after kidney transplant: In this case, the patient has already had a kidney transplant (brain death donor or living donor) and then pancreas transplant is performed.
3- Pancreas transplant alone: This type is performed in patients whose diabetes treatment is associated with severe complications such as dangerous hypoglycemia.
Stages of pancreas transplantation
Pancreas transplantation has four stages:
Step 1: Pre-transplant evaluations
The transplant team carefully evaluates the patient to first determine if pancreatic transplantation will be beneficial for him. And secondly, is the patient physically and mentally ready for the transplant? At this stage, several examinations and tests will be performed on the patient.
Step 2: Prepare for the transplant
At this stage, when the patient enters the transplant waiting list, it is necessary to keep in touch with the transplant team and inform them of any changes in their physical condition or medications. The patient should make sure that the transplant team has all of their phones so that they can contact them. The patient should follow his diet and medication and avoid smoking and alcohol.
Step 3: Transplant surgery
Once a suitable organ is found for the transplant, the transplant team will contact the patient to go to the hospital. At this stage, the patient should avoid eating and drinking. The person’s pancreas remains in the body and a new organ in the abdomen will attach to his arteries. This surgery will take 3 to 4 hours. If the operation is accompanied by a kidney transplant, the operation time will be longer. After the operation, in the intensive care unit, vital signs, organ function and transplantation will be carefully monitored. Gradually, as the condition stabilizes, the patient will be transferred to the transplant ward. The duration of hospitalization is between 12 and 14 days. After the operation, the patient will be prescribed several drugs, the most important of which are anti-transplant drugs. Because the body recognizes the transplanted organ as non-native and tries to repel it, anti-transplant drugs weaken the immune system and prevent the transplant from being rejected. Blood flow to the transplanted organ is assessed by ultrasound. Sometimes other tests or pancreatic biopsies will be needed.
Step 4: Post-transplant care
After recovery, the patient will be discharged from the hospital. At this stage, the patient is regularly examined and tested at the transplant center. It is necessary to take your medication regularly and on time and take any new medication and any changes in your condition, such as fever and chills, abdominal pain, burning urination, high or low blood sugar, cough, shortness of breath, high blood pressure, intolerance Report medications, diarrhea, vomiting, weight loss, or weight gain to the transplant team. It is better for the patient to walk slowly and be physically active.
Common complications after pancreas transplantation
1- Transplant rejection: Today, the rate of transplant rejection has reached less than 10% due to the drugs used. In many cases, transplant rejection has no specific symptoms and is determined by a blood test. Therefore, patients should perform these tests on time and inform the transplant team about the results. In many cases, transplant rejection can be treated.
2- Infection: Due to the use of anti-transplant drugs, the body will be susceptible to infection. Therefore, any abnormal signs should be reported to the transplant team immediately.
3- Blood pressure: Some anti-transplant drugs will make the patient prone to high blood pressure. This can damage the heart, kidneys and brain. Therefore, the transplant team should be notified to begin treatment.
4 – Hyperlipidemia: Some anti-transplant drugs will predispose the patient to hyperlipidemia that must be treated.
5- Skin cancer: Transplant patients are prone to skin cancer. Physicians should be notified immediately of any bumps, moles or skin changes. Patients should avoid direct exposure to sunlight and use a hat and sunscreen.
Pancreatic transplantation, by treating diabetes, will give new life to the patient and improve its quality. Therefore, this organ must be well cared for.
Dr. Reza Saidi Firoozabadi – Transplant surgeon