Who Needs Pancreas Transplant
Despite insulin therapy, some people with type 1 diabetes may still experience wide and unpredictable fluctuations in blood sugar levels, putting them at great risk for severe complications such as kidney failure, and impacting their quality of life. A pancreas transplant may be a treatment option for this select group.
While type 1 diabetes is by far the main indication for a pancreas transplant, in rare instances those who experience either a traumatic loss of the pancreas or chronic pancreatitis (inflammation of the pancreas) may also benefit from transplant. However, people with type 2 diabetes, where the pancreas produces insulin but the body is unable to use it properly, generally do not benefit from a pancreas transplant.
Indications for Pancreas Transplant
A pancreas transplant may be an option for you if you have type 1 diabetes (also called diabetes mellitus) and any of the following severe symptoms and/or complications brought on by type 1 diabetes, have been unable to benefit from insulin therapy, and are experiencing a deteriorating quality of life:
- End-stage kidney disease
- Currently on dialysis
- Received a prior kidney transplant because of complications related to type 1 diabetes
- Hypoglycemia unawareness
- Severe metabolic complications
- Persistent failure of insulin therapy
The American Diabetes Association considers pancreas transplant a viable treatment option for patients with end-stage kidney disease due to type 1 diabetes mellitus. We do not offer pancreas transplantation to type 2 diabetics.
Three Types of Pancreas Transplants
Pancreas transplantation for people with type 1 diabetes can take place in one of three ways:
- Simultaneous pancreas and kidney transplantation (SPK), when the two organs are transplanted at the same time, from the same deceased donor. If you have kidney failure related to your diabetes, you may benefit from SPK.
- Pancreas transplantation after kidney (PAK), when surgeons transplant a pancreas from a deceased donor after a previously transplanted kidney (from either a different deceased donor or from a living donor). If you already have a transplanted kidney, you may benefit from a pancreas transplant in order to control your diabetes and prevent recurrence of diabetic kidney disease.
- Pancreas transplantation alone, from a deceased donor, if you experience dangerous fluctuations in blood sugar levels, despite insulin therapy. By normalizing glucose metabolism, a successful pancreas transplant may also reduce your risk of kidney damage.
Research Supports SPK and PAK
Many people with type 1 diabetes who need a kidney transplant could also benefit from a pancreas transplant. If your diabetes has led to severe kidney disease and you are about to go on dialysis, you may be considered for a simultaneous pancreas/kidney transplant. Sometimes the two organs can be transplanted at the same time, from the same deceased donor. Most often, a kidney becomes available from a living donor first, followed by a pancreas transplant from a deceased donor.
For a host of medical, scientific and emotional reasons, a living donor may be your best option for the kidney transplant. A living donor offers you the chance of a preemptive kidney transplant; that is, a transplant before end-stage kidney failure and chronic maintenance dialysis. It is unclear why patients with diabetes who start dialysis tend to do poorer when they have a transplant, but experts believe it could be because diabetes increases the risks of other disease, including vascular problems. So having a preemptive kidney transplant - just before dialysis is needed - can improve outcome. Additionally, for certain patients with type 1 diabetes, research shows that pancreas after kidney (PAK) transplantation helps:
- Normalize blood sugar control without the need for insulin injections
- Improve the longevity of the kidney transplant
- Prevent recurrent kidney disease, brought on by diabetes, in the transplanted kidney
- Stabilize, and possibly reverse, a number of diabetes-related conditions such as kidney disease, nerve dysfunction and eye disease in some patients
- Improve overall quality of life
Click here to read more about the benefits of whole organ pancreas transplantation, as a solitary graft or in combination with a kidney transplant, in an article written by BIDMC nephrologist Martha Pavlakis, MD,
Transplantation for Type I Diabetes: Whole Organ Pancreas and Islet Cells was published in Current Diabetes Reports.
Pancreas Transplant Alone
Patients with type 1 diabetes who suffer from severe complications, such as serious eye disease, or life-threatening bouts of low blood sugar, may benefit from a pancreas transplant alone. These are people who may either have early signs of kidney disease or whose kidneys are still working well, but who have dangerous hypoglycemic unawareness. They pass out frequently because they are completely unaware that their blood sugar is getting low. Having one of these episodes while driving a car or sleeping can be life threatening. Apart from regulating blood sugar, a new pancreas for these patients may protect against kidney disease and other long-term complications of diabetes.
Best Treatment Plan to Improve Quality of Life
Our transplant team can help you decide if a pancreas transplant is right for you, and if so, which type of transplant is best (simultaneous pancreas/kidney, pancreas after kidney, or pancreas alone). Patients with successful pancreas transplants report an improved sense of well-being that comes from less restrictions around diet and activities, and complete freedom from daily glucose monitoring and insulin injections.