Transplantation of Pancreas

The pancreas is a very important organ. It has two main functions. It produces enzymes that are essential to digest food. It also produces hormones to regulate blood glucose.

There are two hormones called glucagon and insulin. Glucagon is released when blood glucose falls too low. It stimulates the liver to release glucose into the bloodstream. Insulin is released when glucose levels are high. It pushes glucose into muscles and blood glucose falls.

There are two types of diabetes called type 1 and type 2. Type 1 diabetes usually starts in children and adolescents. It is caused by the immune system destroying the body’s own cells that produce insulin. There is a shortage of insulin and insulin injections are usually needed from an early stage. Type 2 diabetes is sometimes called “maturity onset diabetes”. It is affecting more young people as we see far more obesity in young people. The underlying problem is resistance to the effects of insulin and so, at least at first, insulin levels are high. They might fall as the disease progresses and the pancreas becomes exhausted.

Transplantation of a pancreas is not standard treatment for any form of diabetes but it may be tried in type 1 where there is poor control and complications. It is not a substitute for compliance with diet, exercise and medication. Quite often transplantation of a pancreas is performed at the same time as transplantation of a kidney. This is because complications of poorly controlled diabetes have already led to kidney failure. If you are accepted as a potential recipient of a pancreas you must continue to try hard to control your diabetes as best you can. This includes blood pressure and blood cholesterol.

There are two major problems with transplantation of a pancreas. There is a shortage of donors and the transplant is from a different person and so there is a risk of rejection. It is essential to get a good match of tissue type to reduce the risk of rejection. Nevertheless, it will be necessary to take medication to suppress the immune system to prevent rejection. These medicines have a number of problems including reducing resistance to infection. They usually include steroids such as prednisolone. They elevate blood glucose and can even cause diabetes in those who did not previously have it. It is much more difficult to control diabetes in a person taking steroids.

People who have had a successful pancreas transplant may find that their diabetes is gone and they do not need insulin injections. Many may find that they still need some insulin but rather less and the overall control of the disease is much better.

The results of this treatment will vary between specialist centres and we can expect better figures as the years go by but the following may give an indication of what to expect:
• About 85% of people who receive a pancreas and kidney transplant together have a functioning pancreas after one year. The rate drops to about 70% after five years.
• About 80% of those who receive a pancreas after having had a kidney transplant have a functioning pancreas after one year. The rate drops to about 55% after five years.
• About 75% of people who have a pancreas-only transplant have a functioning pancreas after one year. The rate drops to about 55% after five years.

Dr Tony Woolfson MB BS DM MRCP(UK)
Learn how to master your diabetes.  Visit my website at www.diabetesdietdoctor.com.