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Monday, February 11, 2008

Pancreas transplant: An insulin-free treatment for type 1 diabetes

A pancreas transplant is a potential cure for advanced type 1 diabetes. Learn what to expect of the transplant process, the surgery itself and follow-up care.

Type 1 diabetes is a condition in which your pancreas produces little or no insulin, a hormone that allows sugar (glucose) to enter your cells. Treatment for type 1 diabetes is a lifelong commitment of monitoring blood sugar, taking insulin, eating healthy foods and maintaining a healthy weight. For some people, however, insulin therapy and healthy lifestyle choices aren't enough.
If you have severe type 1 diabetes that isn't being successfully managed with insulin therapy, you might be a candidate for a pancreas transplant. A successful pancreas transplant may eliminate the need for insulin therapy.

How does the pancreas lose its ability to produce insulin?

The pancreas releases enzymes into your small intestine to break down nutrients. It also releases hormones into your bloodstream to help your body use glucose. One of these hormones, insulin, lets glucose enter your cells. Glucose is a main source of energy for the cells that make up your muscles and other tissues.
Throughout the pancreas are clusters of specialized cells that produce insulin. When you have type 1 diabetes, your immune system — which normally protects you from viruses and bacteria — attacks and kills these cells. This may occur through a combination of factors, including a genetic predisposition or exposure to certain viruses.
Without insulin, glucose can't get into your cells. Lack of insulin can lead to potentially fatal complications. High blood sugar, which can eventually damage your blood vessels and other tissues, is a particular concern. Your eyes, nerves and kidneys are particularly susceptible to this damage.

Who might be considered a candidate for a pancreas transplant?

A pancreas transplant offers a potential cure for type 1 diabetes, but it's not a standard diabetes treatment. Often, the side effects of a pancreas transplant are more serious than the diabetes. If your diabetes treatment plan is working, a pancreas transplant isn't likely a better option. But if your diabetes can't be controlled or you have serious diabetes-related complications, a pancreas transplant may be worthwhile.
The lack of suitable donor pancreases is a major obstacle in the use of pancreas transplants.

Are there different types of pancreas transplants?

If you have frequent insulin reactions or poor blood sugar control and relatively healthy kidneys, your doctor may recommend a pancreas-only transplant. Often, however, a pancreas transplant is combined with a kidney transplant or done after a successful kidney transplant. The strategy is to give you a healthy kidney and a pancreas that's unlikely to contribute to diabetes-related kidney damage in the future.
You might also be a candidate for an islet cell transplant. With this experimental transplant procedure, only the insulin-producing cells from a donor pancreas — not the entire organ — are transplanted into your body.
What should I consider when choosing a transplant center?
If your doctor recommends a pancreas transplant — either alone or combined with a kidney transplant — you may be referred to a transplant center. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.
When you're considering transplant centers, ask about the number and type of transplants the center performs each year, as well as its organ and recipient survival rates. You can compare transplant center statistics through a database maintained by the Scientific Registry of Transplant Recipients.
Also consider additional services provided by the transplant center. Many transplant centers coordinate support groups, assist with travel arrangements, help secure local housing for the recovery period and offer referrals to other helpful resources.

Do I need to be accepted by the transplant center?

When you select a transplant center, you'll need an evaluation to determine whether you meet the center's eligibility requirements for a pancreas transplant. The team at the transplant center will assess whether you:
  • Are healthy enough to have surgery and tolerate lifelong post-transplant medications
  • Have any medical conditions that would hinder transplant success
  • Are willing and able to take medications as directed
  • Have family and friends to support you during this stressful time

What can I do to prepare for the pancreas transplant?

Whether you're waiting for a donated pancreas to become available or your transplant surgery is already scheduled, it's important to keep your mind and body healthy.
  • Take your medications as prescribed.
  • Follow your diet and exercise guidelines.
  • Keep all appointments with your health care team.
  • Stay involved in healthy activities, including relaxing and spending time with family and friends.
  • Keep a positive outlook.
  • Consider joining a support group.
If you're waiting for a donated pancreas — which can take several years or even longer — make sure the transplant team knows how to reach you at all times. Keep your packed hospital bag handy, and arrange transportation to the transplant center in advance.

What happens during the transplant?

Pancreas transplant surgery usually lasts about three hours. Simultaneous kidney-pancreas transplant surgery takes a few more hours.
The surgeon will place the new pancreas and a small portion of the donor's small intestine into your lower abdomen. The donor intestine will likely be attached to your small intestine, and the donor pancreas will be connected to blood vessels that supply blood to your legs. Your own pancreas will probably be left in place to aid digestion. If you're also receiving a kidney transplant, the blood vessels of the new kidney will be attached to blood vessels in the lower part of your abdomen. The new kidney's ureter — the tube that links the kidney to the bladder — will be connected to your bladder.
Your new pancreas should start working immediately, and your old pancreas will continue to perform its other functions. If you have a new kidney, it'll make urine just like your own kidneys did when they were healthy. Often this starts immediately. In other cases, urine production takes up to a few weeks.
Expect soreness or pain around the incision site while you're healing. Recovery time in the hospital is usually about one week, followed by close monitoring for an additional three to four weeks. During this time, you'll need to stay fairly close to the transplant center.

What can I expect after the transplant?

Even with the best possible match between you and the donor, your immune system will try to reject the new pancreas. Your drug regimen will include medications to suppress your immune system. You'll likely take these or similar drugs for the rest of your life.
Some of these medications may cause noticeable side effects. Steroid-like medications can make your face become round and full. You may gain weight, develop acne or facial hair, or experience abdominal problems. These effects may decrease as time goes on.
Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications. Some immune system medications can also increase the risk of developing or aggravating certain conditions, such as high blood pressure, high cholesterol and cancer.
Your post-transplant treatment will be a delicate balancing act between preventing rejection and managing unwanted side effects. Your doctor will monitor your treatment closely and adjust it as needed. You'll also need to follow a diet designed to keep your new pancreas healthy.

What are typical survival rates?

A pancreas transplanted along with a kidney is more likely to survive than a pancreas transplanted alone. According to the Organ Procurement and Transplantation Network:
  • About 85 percent of people who receive a simultaneous pancreas-kidney transplant have a functioning pancreas after one year. The rate drops to about 70 percent after five years.
  • About 78 percent of people who receive a pancreas-after-kidney transplant have a functioning pancreas after one year. The rate drops to about 56 percent after five years.
  • About 73 percent of people who receive a pancreas-only transplant have a functioning pancreas after one year. The rate drops to about 53 percent after five years.

What if my new pancreas fails?

A pancreas transplant offers no guarantees. Your new pancreas may fail because of organ rejection or other factors that can't be controlled. If this happens, you can resume insulin treatments and consider a second transplant. This decision will depend on your current health, your ability to withstand surgery and your expectations for maintaining a certain quality of life. Discuss these choices with your doctor, transplant team and family to determine what's best for you.
Via: www.mayoclinic.com

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