Pancreas transplant replaces a damaged, diseased or malfunctioning pancreas with a healthy pancreas from an organ donor. The majority of pancreas transplants (about 90%) involve simultaneous pancreas-kidney transplants for patients with aggressive type 1 diabetes and end-stage renal disease (ESRD). More rarely, a partial pancreas transplant is performed with the availability of a living donor, usually a close relative.
The main function of the pancreas, an organ about the size of a hand that lies behind the lower stomach, is to make insulin, a hormone that regulates the absorption of sugar (glucose) into your cells. Type 1 diabetes, virtually the only condition necessitating a pancreas transplant, results when the pancreas can’t make enough insulin and blood sugar rises to dangerous levels. Type 1 (or juvenile onset) diabetes is an autoimmune disorder in which the body mistakenly attacks and destroys the insulin-producing islet cells of the pancreas.
The primary reasons for performing a pancreas transplant include:
- Type 1 diabetes that can’t be controlled with standard treatment
- Frequent insulin reactions
- Consistently poor blood sugar control
- Severe kidney damage
There are three main types of pancreas transplants:
- Pancreas transplant alone, for patients with type 1 diabetes who have severe, frequent hypoglycemia but adequate kidney function
- Simultaneous pancreas-kidney transplant (SPK), in which the pancreas and kidney are transplanted simultaneously from the same organ donor
- Pancreas-after-kidney transplant (PAK), in which a donor pancreas is transplanted some time after a kidney transplant from a different donor
Today, physicians routinely transplant hearts, kidneys, livers, lungs, the pancreas, intestine and abdominal wall to treat critically ill patients suffering from organ failure. Organ failure can be the result of a large variety of conditions, including inherited disorders, viruses, vascular disease and autoimmune disease.
The first pancreas transplantation was performed in 1966 by a team of physicians including Drs. Kelly, Lillehei, Merkel, Idezuki & Goetz a little more than three years after the first kidney transplant in 1977. The first living-related partial pancreas transplant was performed in 1979.
The prognosis after pancreas transplantation is very good. In recent years, long-term success has improved and risks have been significantly decreased. The survival rate for the first year after transplantation is more than 95%. All transplantation patients need lifelong immunosuppression (anti-rejection drugs). Immunosuppression increases susceptibility to infection, cancer, cardiovascular disease, kidney damage and osteoporosis, but advances in immunology and the development of adult stem cell therapies to significantly reduce or eliminate the need for immunosuppression are promising.