Islets of Hope treatment options for persons with diabetes

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Article disclaimer

Excerpts from NIH Publication No. 04–4693; November 2003; Edited for style and content by Lahle Wolfe

NLM/NIH.gov

American Diabetes Association

Links from Addenbrooke's Hospital, Cambridge University, UK


Pancreas Islet Transplant Information


Site Links Courtesy of KPTransplant

Personal Story about a man that had a kidney and pancreas transplant

Jackson Memorial Hospital Division of Kidney and Pancreas Transplantation

Diabetes Research Institute at the University of Miami

UNOS Transplantation Information Site

Surviving Transplantation

National Kidney Foundation

TransWeb - Transplantation and Donation

Transplant Medications

The Islet Foundation

National Transplant Assistance Fund

The Insulin-Free World Foundation

Fast Track to a Cure

Diabetes Portal.org

Children with Diabetes.org

The Voice Of The Diabetic-Quarterly Magazine

Diabetes Interview

American Diabetes Association

The International Society For Peritoneal Dialysis

Dialysis Units in the USA

Transplant Buddies


According to the U of Southern CA
Pancreas Transplant Program site a successful pancreas transplant can benefit a Type I diabetic person in at least three ways:

  • Some types of diabetes-caused damage to the body may be controlled or partially healed.
  • Insulin injections are no longer needed and the person can enjoy a regular diet.
  • A person typically enjoys greater activity and independence.

Frequently asked questions about pancreas transplants

(answered by SHands Healthcare)

Where do pancreases come from?

How are pancreases selected for transplants?

What is rejection?

Is there anything that can be done to prevent rejection?

What happens after I become a transplant candidate?

What preparation is needed before surgery?

Will my own pancreas be removed?

How long will I be hospitalized?

What happens after I am discharged from the hospital?

Who pays for the pancreas transplant?

 

 

islets of hope diabetes medical library                               main Treatment Options page
Diabetes treatment options

Pancreas transplantation


think like a pancreas  Gary Scheiner, CDE
Think Like a Pancreas:
 Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas"--that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books, Think Like a Pancreas discusses: day-to-day blood glucose control and monitoring, designing an insulin program, measuring insulin to carbohydrate intake and physical activity ,  pluses and minuses of different insulin-delivery  methods, optimal management of diabetes using an insulin pump, hypoglycemia—the best ways to avoid it and treat it , the impact of emotions, stress, illness, and aging , making the best use of your health care team and community resources , plus dozens of other issues that everyone taking insulin needs to understand and master.     IOH Rating 5/5 

Also, see Diabetes Research: Pancreas Transplant , Islet Cell Transplant Research and Pancreas Islet Cell Transplant

Mini Site Index
The Pancreas
Pancreas Transplant
Partial Pancreas Transplant
Types of Pancreas Transplant Surgery
Complications
Prognosis 

The Pancreas

The pancreas is an organ about the size of a hand that is located behind the lower part of the stomach.  A healthy pancreas makes insulin and digestive enzymes that help the use food. Spread all over the pancreas are clusters of cells called the islets of Langerhans. Islets are made up of two types of cells: alpha cells, which make glucagon, a hormone that raises the level of glucose (sugar) in the blood, and beta cells, which make insulin.  

If your beta cells do not produce enough insulin, diabetes will develop.  In type 1 diabetes, the insulin shortage is caused by an autoimmune process in which the body's immune system destroys the beta cells.  In nongestational type 2 diabetes the cause is usually a combination of genetic predisposition and an unhealthy lifestyle.

   


Pancreas Transplant

A pancreas transplant is an organ transplant that involves inserting the pancreas and duodenum of a cadaver into a patient with a disease pancreas.  The diseased pancreas and the duodenum are not removed during the operation. The donor pancreas and duodenum are inserted in the right lower portion of the patient's abdomen and attached to their blood vessels and intestine, however, the pancreas can actually be inserted on the left side as well.  This is sometimes done when a kidney transplant is also being performed at the same time.

At present, pancreas transplants are usually performed in people with insulin-dependent diabetes who have severe complications like impaired hypoglycemia and brittle diabetes.  A pancreas transplant gives the patient a chance to become independent of insulin injections but in exchange, immunosuppressant drugs have to be taken for life.   

Pancreas transplants are not performed on people with certain conditions, including:

  • Untreatable cancers
  • Infections that cannot be completely treated or cured, such as tuberculosis
  • Severe heart, lung, or liver problems or complications from diabetes that would make the operation too risky

More About Pancreas Organ Transplants
From NLM/NIH.gov

The healthy pancreas is obtained from a donor who has suffered brain-death, but remains on life-support. The donor pancreas must meet numerous criteria to make sure it is suitable.  In addition to insulin, the pancreas produces other secretions, such as digestive enzymes, which drain through the pancreatic duct into the duodenum. Therefore, a portion of the duodenum is removed with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.

The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually inserted in the right lower portion of the patient's abdomen and attachments are made to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder to drain pancreatic secretions.

The operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease.


Partial Pancreas Transplant

There are not enough cadaver pancreases to meet the demand for pancreas transplant surgery.  When a whole (cadaver)  pancreas is not available, a person can receive a portion of a pancreas from a living relative.

When a patient with diabetes is receiving a kidney transplant from a living relative, it is usually beneficial to perform a partial pancreas transplant at the same time.  Since the transplanted kidney will become damaged by diabetes over time, transplanting a partial pancreas from the same donor will help control blood glucose levels and protect the new kidney from further damage. Transplant success seems higher when patients and donors are matched for HLA types, and a pancreas transplanted along with a kidney is less likely to fail than a pancreas transplanted alone.  


Types of Pancreas Transplant Surgery

There are three main types of pancreas transplantation:

  • Simultaneous pancreas-kidney transplant (SPK): In this procedure the pancreas and kidney are transplanted simultaneously from the same deceased donor.  For those suffering from Type I diabetes and renal failure, this procedure allows freedom from dialysis and insulin dependency. The procedure takes approximately five to eight hours for both organs together, and most patients are hospitalized for one to two weeks.
     
  • Pancreas-after-kidney transplant (PAK): This is a procedure where patients who have received a successful kidney transplant would subsequently receive a pancreas transplant. This procedure is performed on patients with Type I diabetes that are receiving immunosuppression for a prior kidney transplant.  A person that has had a previous kidney graft (or with the opportunity to receive a kidney from a living donor) can proceed first with the kidney and then wait for a cadaver pancreas.
     
  • Pancreas transplant alone (PTA)A (PTA) involves transplanting a pancreas from a cadaveric donor to a patient whose kidneys have not yet been affected by diabetes. It is performed on patients with Type I diabetes who are extremely brittle and/or challenged with significant and frequent hypoglycemia unawareness, or in cases where the risks of surgery and potential side effects of immunosuppression are better than the current state of health.  PTA’s are the least common pancreas transplants.


Complications & Prognosis

There are certain risks associated with any surgery.  The risks for any surgery include:

  • Bleeding, which may require transfusion
  • Post-operative infection
  • Scar formation

Some of the risks for any anesthesia include:

  • Heart attack
  • Reactions to medications
  • Problems breathing
  • Dangerous drop in blood pressure

People that do not have heart problems are better candidates for transplant surgery.  

The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional.  According to the American Diabetes Association,  "one to two people in 10 die within a year of getting a pancreas transplant."

After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection and cancer.   


Frequently asked questions about transplants
(answers from Addenbrooke's Hospital, Cambridge University, UK)

  • What is the pancreas and why is it transplanted?
  • Why transplant a whole pancreas and not just the islet insulin producing cells?
  • Is a pancreas transplant suitable for all diabetics?
  • Is it a simple procedure?
  • Do I need to take any other medicines afterwards?
  • Are there any risks?
  • What are the benefits of a pancreas transplant?
  • How successful is it?
  • How long will I be in hospital?
  • Is it dangerous?
  • What happens to my old pancreas?
  • Do I need to continue on a diet?
  • What next?
  •  

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