Pancreas Transplants: Why Are They Performed and What Are the Risks?
Pancreas transplants, like all organ transplants, focus on replacing a damaged organ with a healthy one. By 2016, 53 345 organ transplants were recorded in the Americas, according to the Pan American Health Organization (PAHO). Pancreas transplants are one of the most effective.
The pancreas is an abdominal organ involved in the production of enzymes for digestion and hormones to control blood sugar levels. Pancreas transplants greatly improve the prognosis and quality of life of patients with severe diabetes mellitus by reducing the complications of the pathology.
What do pancreas transplants consist of?
Pancreas transplants are a surgical procedure in which a specialist implants a healthy and functional pancreas, replacing an injured or insufficient one. This intervention can be performed alone, although it’s been shown that in 88% of cases it’s performed simultaneously with a liver transplant.
The specialists extract the pancreas from a brain-dead donor who’s maintained on life support. Once outside of the body, the pancreas can be kept in a cold store for up to 20 hours.
The pancreas transplant surgery is performed over a period of 3 hours. The donated organ is usually placed in the lower right side of the abdomen. The other diseased pancreas stays in the body.
In the procedure, the specialist joins the blood vessels of the donated pancreas with those of the recipient patient. The organ is usually transferred with a donor portion of the duodenum, whereby the latter is fused directly with the intestine or bladder of the recipient.
If the pancreas transplant is associated with a renal transplant, the procedure can take up to 6 hours. The increased duration explains the high estimated effectiveness.
Why do some people need a pancreas transplant?
The pancreas is the organ in charge of insulin production, which is an anabolic hormone capable of lowering blood sugar levels. Diabetic patients are characterized by an imbalance or absence of insulin production.
Pancreas transplantation makes it possible to recover the physiological capacity for insulin production, reducing the alterations and complications associated with diabetes. However, this procedure isn’t the therapeutic standard.
The most common indication for this procedure is in patients with type 1 diabetes mellitus, due to the need for continuous external administration of the hormone. However, doctors have pointed out that some patients with type 2 diabetes mellitus could also benefit from this intervention.
The association of diabetes with renal alterations was what motivated the development of the surgical technique. This fact explains why most of these procedures are carried out simultaneously with, or prior to, kidney transplantation.
Risks of the procedure
Pancreas transplants are an invasive surgical procedure, so it has its complications, as is the case with all other transplants. The general risks of the intervention include adverse reactions to medications and respiratory alterations associated with anesthetics.
On the other hand, there are complications inherent to pancreas transplantation, including thrombus formation, fistulas, inflammation of the pancreas, infections, and organ rejection.
Thrombosis is one of the most common risks of pancreas transplantation, which manifests itself in the first few postoperative days. Thrombi usually form in the venous system as a result of vascular lesions or hemodynamic alterations.
This complication is responsible for the early loss of the donated organ in 5% to 6% of cases. For this reason, the specialist usually prescribes heparin and antiplatelet agents after the intervention, as a prophylactic measure.
These usually occur in conjunction with the donor organ. Early on, they’re the result of technical failures or decreased blood flow in the tissue, while doctors associate their late appearance with viral infections or transplant rejection.
At present, their incidence has decreased, thanks to medical action. Fistulas usually require surgical repair and specific medical treatment.
Inflammation of the pancreas appears as an immediate postoperative complication. This occurs as a result of how the organ was preserved before the intervention and its manipulation.
In most cases, pancreatitis is usually self-limited and doesn’t affect the functionality of the organ.
The suppression of the immune system and the diabetic health issue itself increase the risk of infections. Therefore, it’s essential to establish antibiotic therapy and continuous monitoring.
5. Acute rejection
Rejection of the donated pancreas occurs in more than 20% of transplanted patients. In this situation, early treatment is essential in order to achieve the best prognosis for the patient.
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Preparation for a pancreas transplant
Pancreas transplantation involves a complex preparation process, both physically and psychologically. Different variables condition it before, during, and after the procedure.
Before the procedure
Once the specialist indicates the need for a pancreas transplant, they’ll provide information on the centers qualified for the procedure. Likewise, the patient is free to investigate and choose the center of their preference.
The team in charge will start a period in which they’ll thoroughly evaluate the patient; this usually lasts from 1 to 2 months. In addition, the specialists ask for different laboratory tests in order to ascertain the recipient’s state of health.
The following are some of the tests:
- Blood test
- HIV test
- Chest X-ray
- Renal function tests
- Electrocardiogram and echocardiogram
- Complete psychological examination
Upon determining that the person is suitable for the procedure, the medical center will add them to a waiting list, according to the patient’s health status and need.
The waiting period for a pancreas transplant can be up to 2 years, depending on the country. In the case of a simultaneous kidney transplant, the time can vary from 12 to 14 months.
Likewise, while waiting for the operation, it’s important to maintain a good state of health. To do so, follow these recommendations:
- Attend all medical consultations and follow the specialist’s instructions
- Maintain a healthy weight, with a balanced diet and light to moderate exercise
- Avoid alcohol and tobacco consumption
- Perform relaxing activities that contribute to psychological health
Prepare everything you need for the operation
During the operation
Doctors perform pancreas transplants under general anesthesia. They can administer the anesthesia as a gas or as an intravenous injection.
The doctor will make an incision in the abdomen, which they’ll use for the implantation of the donor organ and its proper integration with the other organs of the recipient.
The medical team will maintain strict control of all the patient’s vital signs. The procedure usually takes 3 hours and sometimes even more in case of simultaneous transplants.
After the procedure
Once the procedure is over, the recipient patient will stay in the intensive care unit (ICU) for a couple of days to monitor any complications. Then, they’ll transfer the patient to a recovery room for a week.
Upon discharge from the medical center, the monitoring team may ask the patient to stay close to the center for 2 to 3 months. Strict medical control and surveillance are essential.
The specialist will prescribe several medications that the patient must take to avoid complications. Immunosuppressive drugs favor the body’s acceptance of the new organ and help to prevent rejection. However, it’s also important to take antibiotics to keep infections from developing.
Eating tips after a pancreas transplant
Once at home, it’s essential to follow a healthy diet that favors the recovery of the pancreas and the maintenance of its functions. Likewise, diet combined with exercise allows weight control.
In addition, assessment by a nutrition specialist is vital. In general terms, the main recommendations for a healthy diet after a pancreas transplant are the following:
- A diet rich in animal proteins, such as poultry, fish, and lean meats
- A high percentage of fruits and vegetables; at least 5 servings a day
- Foods rich in fiber
- Low-fat dairy products
- Decreasing the consumption of salt and saturated fats
- Limiting the consumption of caffeine and alcohol
- Drinking plenty of water and fluids
- Avoiding acidic fruits and juices, such as grapefruit and orange
- Medications are the best allies
After a successful pancreas transplant, the patient will no longer need to take insulin for the rest of their life. In addition, diseases associated with high blood sugar levels will decrease in incidence.
However, in most cases, the body will be in continuous rejection of the new organ. Therefore, sustained immunosuppressive medication, which can be maintained for the rest of the patient’s life, is key. In addition, an ongoing medical evaluation will provide the tools for a healthy and complication-free life.