Islets of Hope treatment options for persons with diabetes
Excerpts from NIH Publication No. 04–4693; November 2003; Edited for style and content by Lahle Wolfe
Links from Addenbrooke's Hospital, Cambridge University, UK
Site Links Courtesy of KPTransplant
Jackson Memorial Hospital Division of Kidney and Pancreas Transplantation
The Voice Of The Diabetic-Quarterly Magazine
According to the U of Southern CA
Frequently asked questions about pancreas transplants
(answered by SHands Healthcare)
main Treatment Options page
Gary Scheiner, CDE
Also, see Diabetes Research: Pancreas Transplant , Islet Cell Transplant Research and Pancreas Islet Cell Transplant
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.
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:
More About Pancreas Organ Transplants
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:
Complications & Prognosis
There are certain risks associated with any surgery. The risks for any surgery include:
Some of the risks for any anesthesia include:
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
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Page Updated 08/12/2006