Pancreas transplantation is done for people with diabetes whose pancreas cannot make any insulin. It is a major operation, requiring a long incision in the abdomen and a general anesthetic. The recipient's pancreas is not removed. Typically, the operation takes about 3 hours and the hospital stay is 1 to 3 weeks.
More than 80% of people with diabetes who receive a pancreas transplant have normal blood sugar levels afterward and no longer need insulin, but they trade this for the need to take immunosuppressants, with the risk of infections and other side effects. Because injectable insulin is a safe and reasonably effective treatment for diabetes, pancreas transplantation is usually done only in certain diabetic people. People who are most likely to benefit include those who repeatedly have life-threatening low blood sugar levels from use of insulin, and those who also need a kidney transplant. People who need a kidney transplant need to have their abdomen opened and to take immunosuppressants anyway, so they incur few additional risks if they receive a pancreas transplant at the same time.
Pancreatic Islet Cell Transplantation
The cells in the pancreas that produce insulin are called islet cells. Islet cells may be separated from the pancreas of a deceased donor. The islet cells are then transplanted by injecting them into a vein that goes to the liver. The islet cells lodge in the small blood vessels of the liver, where they can live and produce insulin. Sometimes two or three infusions are done, requiring two or three deceased donors.
Some people must have their pancreas removed because of disorders such as chronic pancreatitis (see Pancreatitis: Chronic Pancreatitis). Such people will then become diabetic even if they were not diabetic previously. After the pancreas is removed, doctors can sometimes harvest the islet cells from the person's own pancreas. These islet cells can then be transplanted back into the person's body (autologous transplantation). Because the cells are the person's own, immunosuppressants are not needed.
Transplanting islet cells is simpler and safer than a pancreas transplant, and about 75% of people who receive an islet cell transplant no longer need insulin. However, the long-term success of islet cell transplantation is not yet proved.
Last full review/revision September 2008 by Martin Hertl, MD, PhD; James F. Markmann, MD, PhD; Paul S. Russell, MD; Heidi Yeh, MD