The Pancreas Transplant Operation
There are risks with any surgery, and general anesthesia in particular. But with advances in surgical technique, pharmaceutical breakthroughs, transplanted pancreases are lasting longer and functioning better. Transplantation success improves overall patient survival rates and enriches the quality of life. Some patients transplanted at BIDMC have had their transplanted pancreas for more than 10 years.
Pancreas Transplantation a Specialty Area at BIDMC
Our Transplant Institute, in collaboration with Joslin Diabetes Center, has a highly regarded pancreas and kidney transplant program, with special emphasis on living donor kidney advocacy. Together we have established one of the more active pancreas transplant programs in New England. Patients benefit from the clinical strengths of both institutions, including pre-transplant, inpatient and post-transplant care.
Surgical experience and expertise is especially important for a good outcome because the pancreas can be a finicky organ at times. Surgeons at the Transplant Institute have extensive training in adult pancreas transplantation. Patients benefit from a number of technical improvements in the operation itself, such as the use of blood thinners after surgery to prevent clotting in the graft, and BIDMC protocols featuring rapid steroid withdrawal to help reduce side effects.
Pancreas after kidney transplantation in patients with diabetes is a special area of proficiency at BIDMC. In addition to our surgical experience and multidisciplinary teamwork, pancreas transplant patients benefit from immunosuppressive protocols to minimize the effects of chronic steroid use. Many of our pancreas transplant patients have already undergone a successful kidney transplant, and are already receiving immunosuppression medication to prevent organ rejection. So the surgical procedure to transplant the pancreas is the primary additional risk they face.
Transplanting a pancreas generally takes 2 to 4 hours to complete. The surgeon begins by making a straight incision in the middle of your abdomen, from your navel to the pubic bone.
The surgeon does not remove your diseased pancreas. It remains in place to help with digestion.
The surgeon inserts the donor pancreas into the right side of your abdomen, and connects the blood vessels from the new pancreas to the large arteries and veins that supply blood to the leg. A segment of the duodenum, or small intestine, comes attached to the donor pancreas. The transplant surgeon sews this donor segment to your small intestine. In this way, digestive enzymes from the donor pancreas can drain into your small intestine to help with digestion.
The transplanted pancreas performs all the functions that a pancreas performs in healthy people: producing digestive juices and hormones, including insulin. So after the operation you will no longer need to take insulin injections.
Transplanting a Pancreas and Kidney Together
Some people may receive a kidney/pancreas transplant at the same time, which can take from 3 to 6 hours to complete. Both organs are placed through the same midline incision, with the pancreas placed on the right side, and the kidney on the left (if you still have one or both original kidneys, the surgeon does not remove them during this operation). Usually the surgeon transplants the pancreas first.
With the pancreas in place, the surgeon connects the artery and vein of your new kidney. The artery to the kidney is sewn into the side of the artery that supplies blood to your leg and lower abdomen. The vein to the kidney is sewn into the side of the vein that drains blood from your leg and lower abdomen. The surgeon will also attach the donor kidney's ureter - the tube that carries urine - to your bladder. The surgeon may also place a stent, or tube, in the ureter to hold it open and protect it until it has healed. There is absolutely no discomfort associated with a stent. A urologist will remove the stent during an office visit several weeks after surgery.
The team will close your incision with staples or sutures and cover the area with a gauze dressing. With the operation complete, you will go to the post anesthesia care unit (PACU), and from there, to the Farr 10 transplant unit. The surgeon will let your family members know how you are doing.