The usual treatment for diabetes is to take insulin to replace what the pancreas is not producing. Careful monitoring of blood sugar levels to achieve the correct insulin dosage may prevent or slow many diabetic complications.
Another treatment to restore insulin production is a pancreas transplant. Transplants, however, aren't recommended if patients can manage the disease through diet, medication or other means because the procedure has all the risks and recovery issues of major surgery as well as the risk of organ rejection.
To prevent rejection, patients must take powerful anti-rejection medications for the rest of their lives. These medications have many side effects and makes patients more susceptible to other illnesses.
Because there's a shortage of donor pancreases, patients must wait for an available organ. These wait periods vary depending on blood type. In general, pancreas and kidney-pancreas wait times are shorter than the wait times for a kidney alone.
Simultaneous Kidney-Pancreas Transplant
One of the most serious complications of type 1 diabetes is end-stage renal disease (ESRD) or end-stage kidney disease, which may require a kidney transplant. A kidney transplant without a pancreas transplant means you must take antirejection medication for the kidney and continue to take insulin.
The possibility of diabetes damaging the new kidney and other organs also remains. Successful combined kidney-pancreas transplants prevent diabetic damage in newly transplanted kidneys as well as eliminate the need for insulin therapy. In the best case scenario, a patient would receive a new kidney and pancreas from the same donor .
Solitary Pancreas Transplant
By the time diabetes causes end-stage kidney failure, other complications of the disease often occur. Improvements in surgical techniques and immunosuppressive medications make it possible to perform solitary pancreas transplants for diabetic patients who don't yet have serious kidney disease but who have problems maintaining normal blood sugar and insulin levels.
With these improvements, solitary pancreas transplants are achieving the same excellent results of simultaneous kidney-pancreas transplants.
Advances in the prevention of organ rejection also make it possible to perform solitary pancreas transplants in patients who have had successful kidney transplants.
Kidneys and pancreases may be provided by a cadaveric donor, or a person who is brain dead. Kidneys also may be provided by a living donor who donates one of his or her kidneys and survives on the remaining kidney.
We encourage candidates to accept kidney transplants from living donors if a donor is available. A pancreas transplant may follow the kidney transplant six months to a year later if a pancreas becomes available.
While live kidney donors don't have to be blood relatives, they must have a compatible blood type. Donors may be excluded for high blood pressure, obesity, diabetes or history of cancer.
Pancreatic Islet Transplant
Clusters of cells, called the islets of Langerhans, are spread throughout the pancreas. Islets are made up of two types of cells — the alpha cells, which make glucagon, a hormone that raises the level of glucose or sugar in the blood and the beta cells, which make insulin.
In a minimally invasive procedure, insulin-producing beta cells are isolated from a donor pancreas, then injected through the skin into the portal vein of the liver, where they attach to new blood vessels and release insulin. For an average-size person, a typical islet transplant requires about 1 million islets, equal to two donor organs.
The beta cells migrate to the sinusoids of the liver, where they resume normal function. Previous attempts at islet cell transplants, including several at UCSF Medical Center, were hampered by the toxic effects of immunosuppressive drugs on the islet cells and by graft rejection. Less toxic immunosuppressive medications available now have improved the effectiveness of pancreatic islet transplants in several trials.
Signs and Symptoms
The pancreas, located below your liver and under your stomach, is about seven inches long and weighs about 3.5 ounces. It has two main functions
The first is to help digest food by making and releasing enzymes in the upper portion of the small intestine. Carbohydrates, fats and proteins are broken down into small parts that the body uses as nourishment. In addition, the pancreas makes large amounts of sodium bicarbonate, which can make the contents of the stomach less caustic or acidic as they flow through the small intestine. Sodium bicarbonate also helps keep fluids in the body and prevent dehydration.
The other job of the pancreas is to make insulin, a hormone necessary for the body to use carbohydrates properly. If you don't produce insulin, you have a disease called diabetes.
A pancreas transplant can help manage the organ damage that may result from insulin-dependent diabetes. A successful pancreas transplant will eliminate the need for insulin injections, reduce or eliminate dietary and activity restrictions due to diabetes, and decrease or eliminate the risk of severe low blood sugar reactions.
For the evaluation for a pancreas transplant, we will request a number of other tests. Some of them are:
- Blood tests, including an HIV (AIDS) test, within the last year.
- Chest X-ray within the last year.
- Creatinine clearance testing for those not on dialysis. This test, conducted over a 24-hour period, compares how much creatinine — a blood waste product — occurs in the blood and in the urine to evaluate kidney function.
- Echocardiogram within the last two years. This test uses sound to create a picture of heart function.
- Electrocardiogram (EKG or ECG) within the last year.
- Persantine thallium or comparable test within the last two years. This test involves intravenous application of persantine to help expand the arteries and replicate the effect of vigorous exercise, and of thallium, a radioactive isotope detected by X-ray.
- Stool guaiac, which is a test for blood in stools.
- Tuberculosis (TB) skin test.
Any changes in your health will be reviewed by our selection committee, which includes all transplant doctors and nurses. Your transplant eligibility will be reassessed continuously and further medical tests may be required.
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