Pancreas Transplantation

Pancreas transplantation, whether total or segmental, involves replacing the pancreas of a person with donor pancreas. It is currently the sole treatment of Type 1 diabetes mellitus that is able to establish a consistent, insulin-independent, normal sugar (or normoglycemic) state. Pancreas transplantation is usually simultaneously performed with kidney transplantation, and immunosupression treatment is required by this procedure. Transplant of the pancreas alone is not advisable in certain cases, because the risks associated with immunosuppressive therapy may outweigh the advantage of good metabolic control.

Pancreas transplantation can also be performed in diabetes patients who have already undergone a kidney transplant or as an independent procedure on patients whose glucose levels are not easy to control. The first successful pancreas transplantation was done at the University of Minnesota in 1966 with pancreas from a deceased donor. The goal of pancreas transplantation is to establish the same or a comparable ability to control blood glucose levels that normally comes with insulin secretions from a healthy native pancreas, thus making possible an improved quality of life for the diabetic.

Indications

Pancreas transplantation is indicated for patients with end-stage pancreatic disease, primarily Type 1 diabetes mellitus. These types of patients usually have serious diabetes-related complications, especially damage to the nerves and the blood vessels. The risks associated with transplantation surgery and immunosuppressive therapy may be lower than the risks associated with Type 1 diabetes complications.

Complications

Although pancreas transplantation has undergone substantial evolution over the last few years, it is still considered a technically difficult procedure. It is associated with a significantly high surgical complication rate. Complications with other major procedures, such as wound infections, are still present in pancreas transplantation. Complications related to transplant procedures such as organ rejection, and fungal and viral infections are also associated with transplant of pancreas.

Contraindications

Contraindications for pancreas transplantation include:

* severe uncorrectable cardiac or pulmonary disease
* unresolved chronic infections
* significant chronic liver disease
* metastatic or untreatable cancers, and
* significant psychiatric disease

For pancreas transplantation to be considered, the rule of thumb in medical practice is that patients must have a life expectancy of at least five years.

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