A pancreas transplant is a surgical procedure to provide a new source of insulin in the form of a new pancreas for a patient with type 1 diabetes (see below).
The majority of pancreas transplants are performed on people with type 1 diabetes who have kidney failure; the pancreas is transplanted at the same time as a kidney transplant.
1 in 10 of pancreases are transplanted into diabetic patients who don’t need a kidney, but who have life-threatening hypoglycaemic attacks (a serious complication of diabetes caused by high levels of glucose in the blood).
Pancreas transplantation is less common than kidney or liver transplantaiton, and each year around 200 transplants are performed in the U.K.
It is estimated that there are just over 300 people in the UK on the waiting list for a transplant, with a waiting time between one and two years for a transplant due to the shortage of suitable donor organs
The pancreas and type 1 diabetes
The pancreas is a tadpole-shaped organ, around 10-15 cm long, that is located in the top half of the abdomen.
The pancreas has two main functions:
- it produces juices which the body uses to digest fats and proteins
- it produces the hormone insulin which the body needs to break down glucose into energy
In cases of type 1 diabetes the pancreas does not produce any insulin because the insulin-producing cells, the islets, have been destroyed by the patients own immune system.
Most people with type 1 diabetes are able to control the condition with regular injections of insulin. However, a minority of people go on to develop serious complications despite being given the best available treatment, such as:
- end stage kidney disease (loss of the kidneys’ ability to filter waste products from the blood)
- diabetic retinopathy – where high levels of glucose in the blood causes damage to the eyes, which can lead to loss of vision
- diabetic neuropathy – where high sugar levels have damaged the nerves the hands and feet, meaning that sensation is lost and ulcers can occur
- arterial disease, affecting the arteries to the heart and brain
A pancreas transplant is often combined with a kidney transplant to reduce progression of the complications of diabetes.
Read more about why a pancreas transplant is needed.
What happens during a pancreas transplant
A pancreas transplant can be carried out in three ways:
- Simultaneous pancreas-kidney transplant (SPK) - both the pancreas and kidneys are transplanted. This is the most common type accounting for 9 out of 10 transplants and is used in people who have kidney disease as a result of type 1 diabetes.
- Pancreas-after-kidney transplant - a person first receives a kidney transplant from a living donor. This is then followed by a pancreas transplant from a recently deceased donor.
- Pancreas-alone transplant - only the pancreas is transplanted. This is a treatment for patients with very poorly controlled type 1 diabetes who have hypoglycaemic attacks without warning, and which may threaten their life.
Read more about how a pancreas transplant is performed.
Complications
A pancreas transplant is a complicated operation and, like other types of major surgery, there is a risk of complications.
About 1 in 4 people need further surgery in the first few days after transplantation to deal with problems such as infection and bleeding.
There is also the risk of rejection. This is when the immune system (the body’s defence against infection) regards the transplanted pancreas as a foreign body and attacks it.
To prevent rejection a person has to take a type of medication to suppress the immune system (immunosuppressants) for the rest of their life.
Long-term use of immunosuppressants carries its own risk of complications, such as increased vulnerability to infection and cancer.
Read more about the complications of a pancreas transplant.
Recovery
Having a pancreas transplant places a tremendous strain on the body and typically patients are in hospital for 2 to 3 weeks.
Normal activities can usually be resumed after a few months.
Read more about recovering from a pancreas transplant.
Outlook
The outlook for people with a pancreas transplant, especially a SPK type of transplant, is relatively good.
On average a transplanted pancreas would be expected to function properly for ten years.
