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Monday, February 11, 2008

Pancreas Transplantation

Whole pancreas transplantation

In people with type 1 diabetes, the islet cells in the pancreas no longer produce insulin. So it seems logical that giving a new pancreas to a person with type 1 diabetes would cure their disease. Usually it does.
But the cure can be worse than the disease. The body has a complex system for telling its own parts from foreign parts. To fool the body into accepting the donor organ, doctors try to match the donor and recipient for a blood protein called human leukocyte antigen (HLA) type. Patients with a transplanted organ must take immunosuppressive drugs in order to prevent the immune system from fighting the new organ. The side effects of these drugs may be worse than the problems caused by diabetes, and the operation itself is serious. One to two people in 10 die within a year of getting a pancreas transplant. However, there are situations where a person has such severe complications from diabetes that having a pancreas transplant and taking these immunosuppressive drugs is no worse. People with kidney transplants have to use these drugs anyway so, for these people, pancreas transplants can be worthwhile.
When the transplant takes, the patient no longer has diabetes and is unlikely to get it again. Insulin shots and frequent blood glucose testing are no longer necessary. Restoring normal blood glucose levels may stop complications from worsening, although many more studies are needed.
Pancreas transplants can be rejected, and roughly half of them are. Pancreases attached so that they drain into the bladder are rejected less often than pancreases attached in other body sites. When a transplant fails, the person gets diabetes again.
Remember that pancreas transplants work only for people with type 1 diabetes. The major problem in people with type 2 diabetes isn't a failing pancreas, but the body's inability to respond to insulin in the right way.

Partial pancreas transplantation

Unfortunately, there are not enough cadaver pancreases to go around because not enough people sign up to be organ donors, and each pancreas must meet strict guidelines. 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.

Benefits and risks

Pancreas transplants are safest in people who do not have heart or blood vessel disease. Before you get a transplant, your doctor will check your circulatory system to see if it is healthy enough to risk the operation.
As with any operation, the healthier you are, the better you can withstand the physical stress of surgery. Possible side effects of surgery include bleeding and infection.
Immunosuppressive drugs are hard on the body, but people who get transplants must take these drugs the rest of their lives. Azathioprine and cyclosporine, two commonly used drugs, make it more likely for you to get infections and have other side effects. You will need to avoid people who have infections, such as a cold or the flu. Also, you should not be immunized without first checking with your doctor. These drugs can also damage the kidneys. For example, using either of these medicines for many years could increase your risk for some cancers.
A recenty study (JAMA, 2003) has indicated that, for patients with functioning kidneys, survival rates of patients who receive pancreas-only transplants are worse than the survival rates of patients who manage their diabetes with conventional therapy (insulin, diet, etc.). Therefore, the decision to have a pancreas-only transplant should be very carefully considered by both the patient and physician. Because of the lower survival rates seen with pancreas-only transplants, and because a pancreas transplanted along with a kidney is less likely to fail than a pancreas transplanted alone, pancreas transplants are nearly always done only in people with type 1 diabetes who are getting or already have a transplanted kidney.

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