Pancreas transplant: why is it performed and what are its risks?

Organ transplantation is a therapeutic technique focused on replacing a damaged organ with a healthy one. For 2016, 53,345 organ transplants were registered in the Americas, according to the Pan American Health Organization (PAHO). Pancreas transplantation is one of the most effective.

The pancreas is an abdominal organ that is involved in the production of enzymes for digestion and hormones to control blood sugar levels. Pancreas transplantation greatly improves the prognosis and quality of life of patients with severe diabetes mellitus, by reducing complications of the disease.

What is a pancreas transplant?

Pancreas transplantation is a surgical procedure in which a healthy and functional pancreas is implanted, replacing an injured or insufficient one. This intervention can be performed in isolation, although it has been shown that in 88% of cases it is performed simultaneously with a kidney transplant.

The pancreas is removed from a brain-dead deceased donor who is maintained on life support. Once extracted, it can be transported cold for a maximum period of 20 hours.

The pancreas transplant surgery is performed in a period of 3 hours. The donated organ is usually placed in the lower right part of the abdomen. For its part, the other diseased pancreas is not removed during the intervention.

In the procedure, the specialist joins the blood vessels of the donated pancreas with those of the recipient patient. In addition, the organ is usually transferred with a donor portion of the duodenum, so the latter is fused directly with the intestine or bladder of the patient.

In case the pancreas transplant is associated with a kidney transplant, the procedure can be extended up to 6 hours. The increase in duration explains the high estimated effectiveness.

Read also: Symptoms and diagnosis of chronic kidney failure

Why is a pancreas transplant performed?

The pancreas is the organ responsible for the production of insulin, which is an anabolic hormone capable of lowering blood sugar levels. Diabetic patients are characterized by having an imbalance in production or an absence of it.

Pancreas transplantation allows the physiological capacity to produce insulin to be recovered, reducing the alterations and complications associated with diabetes. However, this procedure is not considered the therapeutic standard.

The most common indication for it is in patients with type 1 diabetes mellitus, due to their need for external and continuous administration of the hormone. However, it has been emphasized that some patients with type 2 diabetes mellitus may also benefit from this intervention.

The association of diabetes with kidney disorders was what motivated the development of the surgical technique. This fact explains why most of these procedures occur simultaneously or prior to a kidney transplant.

Risks of the procedure

Pancreas transplantation is an invasive surgical procedure, so it is not without complications, as it happens with the rest of the transplants. General risks of the intervention include adverse drug reactions and anesthetic-associated respiratory disturbances.

On the other hand, there are complications inherent to pancreas transplantation, among which the formation of thrombi, fistulas, inflammation of the pancreas, infections and organ rejection stand out.

1. Thrombosis

Thrombosis represents one of the most common risks of pancreas transplantation, which manifests itself in the first 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 doctor usually prescribes heparin and antiplatelet agents after the intervention, prophylactically.

2. Fistulas

These are pathological communications that usually present at the junction line with the donor organ. Early, they are the product of technical failures or decreased blood flow in the tissue, while their late appearance is associated with viral infections or transplant rejection.

At present, its incidence has decreased thanks to medical action. Fistulas usually require surgical repair and specific medical treatment.

3. Pancreatitis

Inflammation of the pancreas appears as an immediate postoperative complication. This is a product of the type of preservation before the intervention and its manipulation.

In most cases, pancreatitis is usually self-limited and it does not affect the functionality of the organ.

4. Infections

Suppression of the immune system and the diabetic pathology itself increases the risk of suffering infections. Therefore, the establishment of antibiotic therapy and continuous monitoring is essential.

5. Acute rejection

The rejection of the donated pancreas is an obvious reality that manifests itself in more than 20% of transplant patients. In this situation, early therapy is essential to achieve the best prognosis in the patient.

You may be interested in the following article: Why does rejection occur in transplants?

How should the preparation for a pancreas transplant be?

Pancreas transplantation involves a complex process of preparation, both physically and psychologically. It will be conditioned by different variables before, during and after the procedure.

Before the intervention

Once the specialist indicates the need for a pancreas transplant, he will provide information on the centers trained for the procedure. Similarly, the patient is free to investigate and choose the center of their choice.

The team in charge will initiate a period of comprehensive evaluation of the patient that usually lasts from 1 to 2 months. In addition, different laboratory tests will be carried out in order to corroborate the health status of the recipient.

Among the examinations to be carried out, the following stand out:

• Blood tests
• HIV test.
• Chest X-ray.
• Kidney function tests.
• Electrocardiogram and echocardiogram.
• Complete psychological examination.

In determining that the person is suitable for the procedure, the medical center will add you to a waiting list, according to the state of health and the need of the patient.

The waiting period for a pancreas transplant is usually 23 months. In the case of a simultaneous kidney transplant, the time can vary from 12 to 14 months.

Similarly, while awaiting assignment it is important to maintain good health. For this, the following recommendations can be followed:

• Attend all medical appointments and follow the specialist's instructions.
• Keep a healthy weight, with a balanced diet and mild to moderate exercise.
• Avoid the consumption of alcohol and tobacco.
• Perform relaxing activities that contribute to psychological health.

• Prepare everything you need to go to the medical center in a luggage.

During the intervention

Pancreas transplantation is done under general anesthesia. It can be administered as a gas or as an intravenous infusion.

The approach will be made through an incision in the abdomen, which will serve to carry out the implantation of the donor organ and its adequate integration with the other organs of the recipient.

The medical team will keep all vital signs of the patient under strict control. The procedure usually takes 3 hours and it can be extended in case of simultaneous transplants.

After the intervention

Once the intervention is finished, the recipient patient stay in the intensive care unit (ICU) for a couple of days for the follow-up of any complications. The person will then be moved to a recovery room for a week.

Upon discharge from the medical center, the control team may ask the patient to stay close to the center for 2 or 3 months. Strict medical monitoring and surveillance is essential.

The specialist will indicate several medications to be consumed to avoid complications. Immunosuppressive drugs favor the body's acceptance of the new organ and prevent acute rejection. However, it is also important to take antibiotics to prevent the development of infections.

Eating tips after a pancreas transplant

Once at home, It is essential to follow a healthy diet that favors the recovery of the pancreas and maintaining its operation. Similarly, the diet combined with exercise allows weight control.

Assessment by a nutritionist is vital. In general, the main recommendations for a healthy diet after a pancreas transplant are the following:

• Diet rich in animal protein, like poultry, fish, and lean meats.
• High percentage of fruits and vegetables; at least 5 servings a day.
• High fiber foods.
• Dairy products with low fat content.
• Reduce the consumption of salt and saturated fat.
• Limit your consumption of caffeine and alcohol.
• Drink plenty of water and liquids.
• Avoid acidic fruits and games, such as grapefruit and orange.

Medicines are the best allies

Faced with a successful pancreas transplant, the patient you will no longer need to take insulin for the rest of your life. In addition, diseases associated with high blood sugar levels will decrease their incidence.

However, in most cases the body will be in constant rejection of the new organ. Therefore, sustained immunosuppressive medication is key, which can be maintained for the rest of the patient's life. In addition, the continuous medical evaluation will give the tools to have a healthy life free of complications.