Pancreas Transplantation

Amrita Hospital, Kochi pioneered pancreas transplant in the state of Kerala. First simultaneous pancreas plus kidney transplant was performed on 17th August 2014. This was the 3rd such successful surgery in India.A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly.

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Type 1 diabetes that can't be controlled with standard treatment

• Frequent insulin reactions
• Consistently poor blood sugar control
• Severe kidney damage

The pancreas and type 1 diabetes
The pancreas is a tadpole-shaped organ, around 10–15cm long that is located in the top half of the abdomen.
The pancreas has two main functions:

• It produces juices which the body uses to digest carbohydrates, fats and proteins
• It produces the hormone insulin which the body needs to break down glucose into energy

In cases of type 1 diabetes the pancreas does not produce any insulin because the insulin-producing cells, the islets, have been destroyed by the patient's own immune system.
Most people with type 1 diabetes are able to control the condition with regular injections of insulin. However, a small number of people go on to develop serious complications despite being given the best available treatment, such as:

• Kidney failure – when the kidneys are no longer able to filter waste products from the blood
• Diabetic retinopathy – where high levels of glucose in the blood damages the eyes, which can lead to loss of vision
• Diabetic neuropathy – where high sugar levels have damaged the nerves in the hands and feet, meaning that sensation is lost and ulcers can occur
• Arterial disease – which affects the arteries to the heart, legs and brain

A pancreas transplant is often combined with a kidney transplant to reduce progression of the complications of diabetes.

There are three types of pancreas transplantation:

• Pancreas Alone Transplant (PAT): for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function.
• Simultaneous pancreas-kidney transplant (SPK): when the pancreas and kidney are transplanted simultaneously from the same deceased donor.
• Pancreas-after-kidney transplant (PAK): when a deceased donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant.

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.
During a pancreas transplant, the recipient's diseased pancreas is left in place. The donated pancreas is placed in the front part of the abdomen and connected to the lower abdominal blood vessels. The donated duodenum is attached to either the recipient's intestine or bladder so that pancreatic secretions can drain.

Risks

Complications of the procedure

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Anti-rejection medication side effects

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Results

After a successful pancreas transplant, new pancreas will make the insulin the body needs, so no longer need insulin therapy to treat diabetes. But even with the best possible match between recipient and the donor, the immune system will try to reject your new pancreas.
To avoid rejection, recipient needs medications to suppress the immune system. Recipient will have to take these or similar drugs for the rest of life. Because medications to suppress the immune system make the body more vulnerable to infection, doctor may also prescribe antibacterial, antiviral and antifungal medications.