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Transplant: A Treatment for Diabetes?

By Rhonda Mann
Beth Israel Deaconess Medical Center Staff

When Barbara, a retired school library administrator, received a healthy kidney from her sister in October of 2004, and then a pancreas from a cadaver donor three months later, a new chapter in her life began.

"You feel freer," recalls Barbara, whose Type 1 diabetes had destroyed her own kidney over the decades. "I got up on a Saturday and said, 'after 42 years, I'm going to have a different life.'"

The transplants effectively put an end to Barbara's diabetes. She would no longer have to prick her finger throughout the day, take insulin shots or watch when and what she eats.

"My quality of life has changed," she says.

The number of people with diabetes who need a transplant is growing, according to Dr. Martha Pavlakis, medical director of kidney and pancreas transplantation at Beth Israel Deaconess Medical Center, a clinical partner of the  Joslin Diabetes Center.

"There's a greater incidence of diabetes," says Dr. Pavlakis. "There are also more people progressing to kidney failure and living to get a transplant. The medical field has come so far that we are now seeing people who qualify for kidney transplants who 20 years ago would not have survived their original disease."

For many juvenile or Type 1 diabetic patients with severe kidney disease, a combined kidney/pancreas transplant is the best option. Once the pancreas is replaced, insulin can be produced normally, giving a new kidney the best chance of staying healthy. Sometimes the two organs can be transplanted at the same time (if from cadaver donor). Most often, a kidney is made available by a living donor first, then the patient is put on the pancreas waiting list and within a year or two receives a pancreas. Because of advances in surgical techniques and medications, the vast majority of these transplants are successful.

"They have a graft survival rate at one year in the 80-90 percent range meaning the organs were functioning well," according to Dr. Pavlakis.

The best results are among those patients who are referred to a transplant center early on - by what is known as stage four kidney disease, prior to starting dialysis. It's unclear why diabetic patients 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 diseases.

"Those with Type One diabetes tend to have more vascular problems," says Dr. Pavlakis. "One in ten are going to die on dialysis each year."

"Research shows that even six months on dialysis results in worse kidney outcomes and worse patient outcomes," says Dr. Pavlakis. "So there's been more emphasis especially at our center on educating patients and referring physicians about the benefits of having a pre-emptive kidney transplant, that is a transplant just before dialysis is needed."

Another option for a small percentage of diabetic patients -- a pancreas transplant alone.

"There are patients who don't have kidney failure, but have hypoglycemic unawareness-they pass out frequently because they are completely unaware that their blood sugars are getting low," says Dr. Douglas Hanto, Chief of Transplantation at Beth Israel Deaconess Medical Center. "If they are driving a car or have one of these episodes while they are sleeping, it can be life threatening."

While transplantation can be an effective treatment for the sickest of those with diabetes, doctors agree the decision to transplant must be carefully weighed, especially since these patients will need to take immunosuppressive drugs for the rest of their lives.

"These medications decrease our body's ability to fight infections and certain cancers, so there has to be an important reason to be on them," says Dr. Pavlakis.

For Barbara, who is now 62, the transplants have meant a more active, carefree lifestyle. She exercises daily and does six hours of Tai Chi per week.

"I never dreamed I would not have diabetes," says Barbara. "It's just like a second life has been given to me."

Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.

Posted October 2008