Transplantation Of The Pancreas: Why Is It Performed And What Are The Risks?

The pancreas is an organ located in the abdominal cavity whose function can be affected by various pathologies. Transplants are an option that is increasingly being explored.

Like all organ transplants, transplantation of the pancreas focuses on replacing a damaged organ with a healthy one. In 2016, 53,345 organ transplants were recorded in America, according to the Pan-American Health Organization (PAHO). Pancreatic transplants are one of the most effective.

The pancreas is an organ in the stomach that is involved in the production of enzymes for digestion and hormones to control blood sugar levels. Pancreatic transplants greatly improve the prognosis and quality of life of patients with severe diabetes mellitus by reducing the complications of the disease.

What does a pancreas transplant consist of?

Pancreatic transplantation is a surgical procedure in which a specialist implants a healthy and functional pancreas to replace a damaged or insufficient pancreas. This procedure can be performed alone, although it has been shown that in 88% of cases it is performed at the same time as a liver transplant.

The specialists take the pancreas from a brain-dead donor, who is kept alive. Once the pancreas is outside the body, it can be stored in a cold room for up to 20 hours.

The operation for pancreatic transplantation is performed over a period of three hours. The donated organ is usually placed in the lower right side of the abdomen. The other diseased pancreas remains in the body.

At the procedure, the specialist connects the blood vessels from the donated pancreas to the blood vessels from the recipient patient. The organ is usually transferred together with a donor portion of the duodenum, whereby the latter fuses directly with the intestine or bladder of the recipient.

If the pancreas transplant is associated with a kidney transplant, the procedure can take up to six hours. The extended duration explains the high estimated efficiency.

Why do some people need a transplant of

the pancreas?

The pancreas is the organ responsible for insulin production, which is an anabolic hormone that is able to lower blood sugar levels. Diabetic patients are characterized by an imbalance or lack of insulin production.

Transplantation of the pancreas makes it possible to regain the physiological capacity for insulin production and thus reduce the changes and complications associated with diabetes. However, this procedure is not 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 procedure.

It was the link between diabetes and kidney changes that motivated the development of the surgical technique. This explains why most of these procedures are performed at the same time as or prior to kidney transplantation.

Risks of transplantation of the pancreas

Transplantation of the pancreas is an invasive surgical procedure and therefore there are complications, as is the case with all other transplants. The general risks of the procedure include side effects of medication and respiratory changes associated with anesthesia.

On the other hand, there are complications associated with pancreatic transplantation, including the formation of blood clots, fistulas, inflammation of the pancreas, infections and rejection of the organ.

1. Thrombosis

Thrombosis is one of the most common risks of transplantation of the pancreas, which appears in the first days after surgery. Thrombi usually form in the venous system as a result of vascular lesions or hemodynamic changes.

This complication is responsible for early loss of the donated organ in 5-6% of cases. Therefore, the specialist usually prescribes heparin and platelet inhibitors after the procedure as a prophylactic measure.

2. Fistulas after a transplant of the pancreas

These usually occur in conjunction with the donor organ. At an early stage, the technical defects are due to decreased blood flow in the tissue, while doctors associate a late occurrence with viral infections or transplant rejection.

Today, the incidence is reduced thanks to the medical efforts. Fistulas usually require surgical repair and specific medical treatment.

Inflammation of the pancreas

Inflammation of the pancreas occurs as an immediate postoperative complication. This occurs as a result of the way in which the organ was preserved before the procedure and by the manipulation of it.

In most cases, the inflammation is usually self-limiting and does not affect the functionality of the organ.

4. Infections

The suppression of the immune system and the diabetic health problem itself increases the risk of infections. Therefore, it is important to establish antibiotic treatment and ongoing monitoring.

5. Acute rejection

Rejection of the donated pancreas occurs in more than 20% of the transplant patients. In this situation, early treatment is important to achieve the best prognosis for the patient.

Preparation for a transplant of the pancreas

Pancreatic transplantation involves a complex preparation process, both physical and psychological. Different variables condition it before, during and after the procedure.

Before a transplant of the pancreas

The responsible team will initiate a period during which they will evaluate the patient thoroughly. This usually lasts from 1 to 2 months. In addition, specialists ask for various laboratory tests to determine the health status of the recipient.

The following are some of the tests:

Blood test.
HIV test.
X-ray of the chest.
Testing of kidney function.
Electrocardiogram and echocardiogram.
Complete psychological examination.

Once it has been determined that the person is suitable for the procedure, the medical center will add the person to a waiting list according to the patient’s health condition and needs.

The waiting time for a pancreatic transplant can be several years. In the case of a simultaneous kidney transplant, the waiting time may be longer.

Similarly, it is important to maintain good health while waiting for surgery. 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 pancreatic transplants under general anesthesia. They can be given as an anesthetic or as an intravenous injection.

The doctor will make an incision in the abdomen, which they will use to implant the donor organ and integrate it properly with the other organs of the recipient.

The medical team will maintain strict control over all the patient’s vital signs. The procedure usually takes 3 hours and sometimes even longer in the case of concomitant transplants.

After the procedure

Once the procedure is over, the recipient patient will stay in the intensive care unit for a few days to monitor for any complications. They then transfer the patient to a monitoring room for a week.

Once the patient is discharged, the monitoring team may ask the patient to stay near the hospital for 2 to 3 months. Strict medical control and monitoring are essential.

The specialist will prescribe several medications that the patient should take to avoid complications. Immunosuppressive drugs promote the body’s acceptance of the new organ and help prevent rejection. However, it is also important to take antibiotics to prevent infections from occurring.

Dietary recommendations after a transplant of the pancreas

When at home, it is important to follow a healthy diet that promotes the restoration of the pancreas and the maintenance of its functions. Likewise, the diet combined with exercise allows for weight control.

In addition, it is important to have an assessment made by a nutritionist. In general, the most important 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 large proportion of fruits and vegetables, at least five servings a day.
Foods rich in fiber.

Low fat dairy products.
Reducing the consumption of salt and saturated fat.
Limiting caffeine and alcohol consumption.
Drink plenty of water and fluids.
Avoid sour fruits and juices, e.g. grapefruit and orange.
Medicine is the best ally.

After a successful pancreatic transplant , the patient no longer needs to take insulin for the rest of his life. In addition, diseases associated with high blood sugar levels will occur less frequently.

In most cases, however, the body will experience a sustained rejection of the new organ. Therefore, persistent immunosuppressive medication, which can be maintained for the rest of the patient’s life, is important. In addition , a regular medical evaluation will provide the tools for a healthy and complication-free life.