A pancreas transplant is an

organ transplant Organ transplantation is a medical procedure in which an organ (anatomy), organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or org ...

that involves implanting a healthy

pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...

(one that can produce insulin) into a person who usually has

diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

Overview

Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas, which would quickly cause life-threatening diabetes, there would be a significant chance the recipient would not survive very well for long without the native pancreas, however dysfunctional, still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who can develop severe complications. Patients with the most common, and deadliest, form of

pancreatic cancer Pancreatic cancer arises when cell (biology), cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a Neoplasm, mass. These cancerous cells have the malignant, ability to invade other parts of ...

( pancreatic adenomas, which are usually malignant, with a poor prognosis and high risk for metastasis, as opposed to more treatable

pancreatic neuroendocrine tumor Pancreatic neuroendocrine tumours (PanNETs, PETs, or PNETs), often referred to as "islet cell tumours", or "pancreatic endocrine tumours" are neuroendocrine neoplasms that arise from cells of the endocrine (hormonal) and nervous system within ...

s or pancreatic

insulinoma An insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin. It is a rare form of a neuroendocrine tumour. Most insulinomas are benign in that they grow exclusively at their origin within the pancreas, but a m ...

s) are usually not eligible for valuable pancreatic transplantations, since the condition usually has a very high mortality rate and the disease, which is usually highly malignant and detected too late to treat, could and probably would soon return. Better surgical method can be chosen to minimize the surgical complications with enteric or bladder drainage. Advancement in immunosuppression has improved quality of life after transplantation.

Medical uses

In most cases, pancreas transplantation is performed on people with type 1

with end-stage renal disease, brittle diabetes, and hypoglycaemic unawareness. Other type 2 diabetics can benefit from a pancreas transplant. The indications for a type 2 diabetic are a BMI < 30 kg/m2 and low overall insulin requirement (< 1 U/kg/day). The majority of pancreas transplantations (> 90%) are simultaneous pancreas-kidney transplantations.

Complications

Complications immediately after surgery include clotting of the arteries or veins of the new pancreas (

thrombosis Thrombosis () is the formation of a Thrombus, blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fib ...

), inflammation of the pancreas (

pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormone A hormone (from the Ancient Greek, Greek participle , "se ...

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, bleeding and rejection. Rejection may occur immediately or at any time during the patient's life. This is because the transplanted pancreas comes from another organism, thus the recipient's immune system will consider it as an aggression and try to combat it. Organ rejection is a serious condition and must be treated immediately. In order to prevent it, patients must take a regimen of

immunosuppressive drug Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent the activity of the immune system. Classification Immunosuppressive drugs can be classifie ...

s. Drugs are taken in combination consisting normally of

ciclosporin Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken Oral administration, orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephr ...

azathioprine Azathioprine, sold under the brand name Imuran, among others, is an immunosuppressive medication. It is used for the treatment of rheumatoid arthritis, granulomatosis with polyangiitis, Crohn's disease, ulcerative colitis, and systemic lupus er ...

and

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s. But as episodes of rejection may reoccur throughout a patient's life, the exact choices and dosages of immunosuppressants may have to be modified over time. Sometimes

tacrolimus Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After Allotransplantation, allogenic organ transplant, the risk of organ Transplant rejection, rejection is moderate. To lower the risk of organ rejectio ...

is given instead of ciclosporin and mycophenolate mofetil instead of azathioprine.

Types

There are four main types of pancreas transplantation: * Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent

hypoglycemia Hypoglycemia (American English), also spelled hypoglycaemia or hypoglycæmia (British English), sometimes called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's tria ...

, but adequate kidney function. This pancreas transplant known as PTA has as of recently been showing up with good results. This is the least performed method of pancreas transplantation and requires that only the pancreas of a donor is given to the recipient. * Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor. This is the most commonly performed pancreas transplant operation. Indications for an SPK are End Stage Renal Disease with type 1 diabetes (with other diabetic complications like neuropathy, gastroparesis etc.) This is the most common type of pancreas transplantation. The basic reason for this is that patients are mostly already on immunosuppressive drugs and the addition of the kidneys simultaneously reduces the risk in surgical procedure. * Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant. This method is usually recommended for diabetic patients after having a successful kidney transplant. The downside of this procedure is that patients are required to go through surgical risk twice. * Simultaneous deceased donor pancreas and live donor kidney (SPLK) has the benefit of lower rate of delayed graft function than SPK and significantly reduced waiting times, resulting in improved outcomes.

Prognosis

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. After transplantation patients need lifelong

immunosuppression Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse react ...

. Immunosuppression increases the risk for a number of different kinds of infection
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' and cancer. It is unclear if

steroids A steroid is an organic compound with four fused rings (designated A, B, C, and D) arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter mem ...

, which are often used as immunosuppressant, can be replaced with something else.

History

As described by a pioneer in the field, D.E. Sutherland, whole pancreas transplantation began as a part of multi-organ transplants, in the mid-to-late 1960s, at the

University of Minnesota The University of Minnesota Twin Cities (historically known as University of Minnesota) is a public university, public Land-grant university, land-grant research university in the Minneapolis–Saint Paul, Twin Cities of Minneapolis and Saint ...

: The first pancreas transplantation, performed in a multi-organ transplant with kidney and duodenum, was into a 28-year-old woman; her death three month post-surgery did not obscure the apparent success of the pancreatic replacement. It was performed in 1966 by the team of W.D. Kelly, R.C. Lillehei, F.K. Merkel, Y. Idezuki, F.C. Goetz and coworkers at the University Hospitals,

, three years after the first kidney transplantation. The first living-related partial pancreas transplantation was done in 1979. In the successive 1980s period, there was significant improvements in immunosuppressive drugs, surgical techniques, and the preservation of organs. The prognosis is very good with 95% of patients still alive after one year post-surgery and 80-85% of all pancreases still functional.

References

External links

International Pancreas and Islet Transplant Association
{{Authority control Organ transplantation Accessory digestive gland surgery