Pancreas Transplant

You will need a thorough evaluation by the Transplant Institute staff, in consultation with physicians, to determine if transplantation is the best treatment option. Being a good candidate for transplant depends upon your physical health, emotional well being, and ability to manage medication and care plans.

People with type 1 diabetes (inability to produce insulin), chronic pancreatitis or traumatic loss of pancreas may be candidates for a pancreas transplant. However, those with type 2 diabetes, where the body is unable to use the insulin it produces, have a special category to decide if they will benefit from a pancreas transplant.

One of the biggest benefits to a pancreas transplant for people with type 1 diabetes is lifestyle improvement. You will no longer need insulin injections, and you can enjoy a regular diet. Depending on your health before the transplant, you are also likely to experience greater independence and activity. Protection from kidney damage is the other significant benefit because the new pancreas will help prevent high blood sugar from damaging your body.

Following a successful pancreas transplant, your new organ will begin making insulin right away. Initially some hospitalized patients may need to take low levels of insulin so as not to stress the newly transplanted donor pancreas. However, by the time most people are ready to go home, they are no longer taking insulin and they are able to enjoy a regular diet.

Yes, a pancreas transplant will help reduce your risk of vascular disease, but it will not reverse any vascular disease that is present at the time of your transplant. It will prevent progression of retinopathy (a degenerative disease of the retina) and in some cases may reverse already established symptoms of this eye disease. A pancreas transplant will also improve peripheral neuropathy, although strict sugar control will also reverse this condition. With peripheral neuropathy, injury to the peripheral nerves, which carry signals between the central nervous system (spinal column and brain) and the internal organs, muscles and skin, can produce tingling, pain and debilitation.

A pancreas transplant is generally not for patients who have a mild case of type 1 diabetes that responds well to insulin therapy and certain diet restrictions. Some people consider transplant because they do not want to deal with certain lifestyle issues: limitations in diet, monitoring blood levels or needing three and four needle shots a day.
Other patients consider pancreas transplant because they have “brittle” diabetes, with very severe and sudden symptoms and complications from type 1 diabetes. These are people who have dangerous hypoglycemic unawareness. They pass out frequently because they are completely unaware that their blood sugar is getting low. Having one of these episodes while driving a car or sleeping can be life threatening. Apart from regulating blood sugar, a new pancreas for these patients may protect against kidney disease and other long-term complications of diabetes. Some patients with diabetes, who have already received a donor kidney, consider pancreas transplantation to protect their new kidney from health complications from diabetes.

For certain patients with type 1 diabetes, research shows that pancreas after kidney (PAK) transplantation helps improve blood sugar control without the need for insulin injections; improve the longevity of the kidney transplant; prevent recurrent kidney disease, brought on by diabetes, in the transplanted kidney; stabilize, and possibly reverse, a number of diabetes-related conditions such as kidney disease, nerve dysfunction and eye disease in some patients; and improve the overall quality of life.

Patients who need a pancreas transplant are listed with the Zonal Transplant Coordination Centre (ZTCC). ZTCC administers and maintains the national organ transplant waiting list.
Once you register at our hospital. ZTCC will enter your medical information into a computer and will notify our transplant team when an organ becomes available based on your waiting time on the list, blood type and other factors.

There is no guarantee when a deceased donor pancreas will become available. It could be months or years. The average waiting time for a deceased donor pancreas is between 6 months to 1 years. The waiting time is longer for patients with blood type O or B, and shorter for patients with blood type A or AB.

You must always take anti-rejection medications for as long as you have a functioning transplant. You will also need medications to prevent infection for a short time after your transplant. Additionally, you may need at some point in time medications to control blood pressure and prevent fluid retention.
You are responsible for managing your own medication schedule, as determined by the Transplant Institute team. You should never stop taking your medication or change the dose without approval from the transplant team, even if you experience unpleasant side effects. Tolerating some side effects temporarily may be necessary in order to prevent organ rejection. Tell your transplant team about any side effects that bother you. Your doctor may be able to adjust your medication.

Pancreas transplant is successful in about 90 percent of patients who no longer have to take insulin injections within the first year following the surgery. After the first year, more than two-thirds of pancreas transplant recipients are still off insulin. The rate of organ function is very high, with a half-life of about 10 years. In other words, after 10 years, half of the transplanted pancreases are still working, which in terms of organ transplants is very good. Those that are still working typically go on to work for many more years. Surgeons are hopeful that this success rate will climb even higher in the future because of ongoing improvements in medication that support the functioning of the transplanted pancreas.

Rejection is a signal that the patient’s immune system has identified the new pancreas as foreign tissue and is trying to get rid of it. Preventing rejection with immune-suppressing medication is the first priority.
The most common sign of rejection is change in pancreas function (an elevation of pancreas enzymes and/or glucose levels), as measured by a blood test.
If the rejection episode is verified through blood work, biopsy and ultrasound, then the transplant team will increase the amount of anti-rejection medication or prescribe a different combination of anti-rejection drug therapy. Using medicine, we can successfully reverse most rejection episodes, if we detect it early enough. However, if the episode is severe, it may shorten the overall life span of the new pancreas.