Why it's done

A pancreas transplant can restore normal insulin production and improve blood sugar control in people with diabetes, but it's not a standard treatment. The side effects of the anti-rejection medications required after a pancreas transplant can often be serious.

For people with any of the following, a pancreas transplant may be worth considering:

  • Type 1 diabetes that can't be controlled with standard treatment
  • Frequent insulin reactions
  • Consistently poor blood sugar control
  • Severe kidney damage
  • Type 2 diabetes associated with both low insulin resistance and low insulin production

A pancreas transplant usually isn't a treatment option for people with type 2 diabetes, because type 2 diabetes occurs when the body becomes resistant to insulin or unable to use it properly rather than due to a problem with insulin production in the pancreas.

But for some people with type 2 diabetes who have both low insulin resistance and low insulin production, pancreas transplant is an emerging treatment option. About 10 percent of all pancreas transplants are performed in people with type 2 diabetes.

There are several different types of pancreas transplants, including:

  • Pancreas transplant alone. People with diabetes and early or no kidney disease may be candidates for a pancreas transplant alone (solitary pancreas transplant). A pancreas transplant surgery involves only a pancreas transplant without other surgeries.
  • Combined kidney-pancreas transplant. Surgeons often may perform combined (simultaneous) kidney-pancreas transplants for people with diabetes who have or are at risk of kidney damage. More than two-thirds of pancreas transplants are done simultaneously with a kidney transplant.

    The goal of this approach is to give you a healthy kidney and pancreas that are unlikely to contribute to diabetes-related kidney damage in the future. But waiting for a donor pancreas and kidney to become available at the same time may increase time spent on the organ donor waiting list.

  • Pancreas-after-kidney transplant. For those facing a long wait for both a donor kidney and pancreas to become available, a kidney transplant may be recommended first if a living- or deceased-donor kidney becomes available.

    After you recover from kidney transplant surgery, you'll receive the pancreas transplant once a donor pancreas becomes available.

  • Pancreatic islet cell transplant. During pancreatic islet cell transplantation, insulin-producing cells (islet cells) taken from a deceased donor's pancreas are injected into a vein that takes blood to your liver. More than one injection of transplanted islet cells is often necessary.

    Islet cell transplantation is an experimental procedure and may only be performed as part of a Food and Drug Administration-approved clinical trial.

Although it's possible for a living donor to donate part of a pancreas, nearly all pancreas transplants involve a deceased-donor pancreas.

June 24, 2016
References
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