BWH is pleased to announce the addition of a comprehensive Pancreas Transplant Program to our list of services. This section is designed to provide you with information you will need to undergo a successful pancreas transplant.
THE PANCREAS | INDICATIONS | TYPES OF TRANSPLANTS
GOALS OF TRANSPLANTATION | TRANSPLANT EVALUATION
PANCREAS SURGERY | ISLET CELL TRANSPLANTATION
POST TRANSPLANT CARE
The Pancreas
Your pancreas is a narrow organ, about 6 inches long, that lies behind the stomach. The pancreas produces a hormone called insulin that regulates the amount of sugar in the blood. It also makes enzymes that are released into your small intestine and help to digest food. Failure of your body to regulate the amount of glucose in your blood causes Diabetes. In Type 1 Diabetes the pancreas produces little or no insulin. In Type 2 Diabetes, your pancreas produces insulin but your body is not able to utilize it efficiently.
Indications
Pancreas transplantation should be considered an acceptable treatment option for Type 1 diabetics with kidney failure who have had or plan to have a kidney transplant. The successful addition of a pancreas transplant will restore normal glucose control, does not jeopardize patient survival, and may improve kidney survival.
In the absence of indications for kidney transplantation, pancreas transplantation should only be considered in insulin dependant diabetics who have a history of frequent acute, and severe metabolic complications requiring medical attention, such as frequent episodes of hypoglycemia, ketoacidosis, or hyperglycemia.
Types of Pancreas Transplants
Simultaneous pancreas- kidney transplants (SPK) - Around 70% of pancreas transplants are performed along with a kidney transplant. The organs come from the same deceased donor.
Pancreas after kidney transplants (PAK) - These are done after a successful kidney transplant. The pancreas comes from a deceased donor, but the kidney transplant may have been from a living donor or a deceased donor organ.
Pancreas Transplant alone (PTA) - In the absence of indications for kidney transplantation, pancreas transplantation should only be done in patients who have poor glucose control and frequent potentially life- threatening complications.
Goals of Pancreas Transplantation
Insulin independence with normal or near normal blood sugars. Prevention of the development and/or progression of the long term complications of diabetes. Improved quality of life, elimination of dietary restrictions.
Pancreas Transplant Evaluation
The evaluation process is similar to kidney transplant evaluation. However patients requiring pancreas transplant may need additional testing such as cardiac catheterization and consultation with endocrinologists and vascular surgery.
Pancreas Surgery
Pancreas transplant surgery is more complex and extensive than a kidney transplant. The pancreas transplant is placed intra- abdominally through a vertical mid-line incision about 8 inches long, as opposed to a kidney which is placed in the 
retroperitoneum (behind and outside your peritoneum). SPK surgery will last about 5-8 hours and a PAK or a PTA surgery usually takes 3-5 hours. The new pancreas is transplanted with a portion of small intestine which drains the digestive enzymes of the pancreas. This will need to be connected to your small intestine or your urinary bladder to provide a drainage for the enzymes. At BWH we prefer the former method as it is more physiological and does not harm your bladder. Your own pancreas will not be removed during the surgery.
Islet Cell Transplantation
Transplant options for the diabetic recipient include whole organ pancreas and islet transplantation. Islet transplantation offers the advantage of being less invasive than whole organ transplantation. However, current experience shows that multiple transplants are required and long-term function remains poor. Early successes with single donor islet transplants were encouraging but insulin independence is usually not sustainable.
Send Feedback to: 
