(See also Overview of Transplantation.)
Pancreas transplantation is done for people who have diabetes if their pancreas cannot make enough insulin. More than 80% of people who have diabetes and who receive a pancreas transplant have normal blood sugar levels afterward and no longer need insulin, but they trade this benefit 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, freedom from insulin is not considered a sufficient reason for pancreas transplantation. Thus, this procedure is usually done only in people with diabetes if:
They also have kidney failure.
They cannot keep their blood sugar levels within an acceptable range, particularly if they do not sense when their blood sugar levels become too low.
(Occasionally, when blood sugar levels remain too low for too long, organs, including the brain, are permanently damaged.)
Overall, more than 90% of people who receive a pancreas transplant receive a kidney transplant at the same time. Kidney transplantation requires abdominal surgery and the use of immunosuppressants afterward, so transplanting a pancreas at the same time adds few risks.
Pancreas transplantation may be beneficial for people who are taking insulin but still have high blood sugar levels and whose blood sugar levels become dangerously low after taking insulin.
Sometimes only certain cells from the pancreas are transplanted (called pancreatic islet cell transplantation).
More than 95% of people survive at least 1 year after transplantation.
Donors are usually people who have all of the following characteristics:
If both a pancreas and kidney are being transplanted, they must come from the same donor.
Parts of a pancreas from a living donor have been used, but this procedure is rarely done because the risks to the donor are high.
The procedure may involve
Pancreas transplantation is a major operation, requiring a long incision in the abdomen and a general anesthetic. The recipient’s own pancreas is not removed.
Typically, the operation takes about 3 hours and the hospital stay is 1 to 3 weeks.
Drugs to inhibit the immune system (immunosuppressants), including corticosteroids, are started the day of transplantation. These drugs can help reduce the risk of rejection.
Transplantation can cause various complications.
Despite the use of immunosuppressants, one or more episodes of rejection occurs in 20 to 40% of people after pancreas transplantation (with or without a kidney).
When a pancreas and kidney are transplanted at the same time, the risk of rejection is higher, but rejection tends to occur later and more often than when only a kidney is transplanted. Usually, both organs are rejected. However, treatment of rejection has a high success rate.