What is Pancreatic Transplant Surgery?
A pancreas transplant is an elaborate surgical procedure to replace natural insulin production and regulate blood sugar levels by replacing a damaged pancreas with a healthy one from a deceased donor. Pancreas transplant surgery is a life-changing surgery that is responsible for eliminating the need for insulin injections in severe type 1 diabetes mellitus patients, a condition where the immune system destroys insulin-producing beta cells in the pancreas. In selective cases, pancreatic transplant surgery is also done for type 2 diabetes, who have both pancreatic and kidney failure. This transplant provides the recipient with the ability to produce and regulate insulin naturally.
The other aims of surgery, or pancreas transplant surgery, are to prevent or reverse diabetic complications like neuropathy, retinopathy, and nephropathy, thus increasing life expectancy and improving quality of life.
Pancreas transplantation is not a common surgery and is used to treat specific conditions like type 1 diabetes mellitus, diabetes with kidney failure, brittle diabetes or labile diabetes, chronic pancreatitis, and type 2 diabetes.
Types of pancreas transplant
Different types of pancreas transplant surgeries can be performed in several ways, depending on the patient’s medical condition and the presence of kidney disease. The major types include
- Pancreas Transplant Alone – is a procedure that is performed in patients with type 1 diabetes who have several metabolic problems but normal kidney function. It replaces the diseased pancreas with a donor pancreas to restore insulin production and regulate the levels of glucose. A pancreas transplant alone is best suited for patients experiencing recurrent, severe hypoglycemia or poor glucose control despite intensive insulin therapy.
- Simultaneous pancreas-kidney transplant (SPK) is the most common type of pancreas transplant surgery. It is performed in patients suffering from both end-stage renal disease and insulin-dependent diabetes. In this combined procedure, both the kidneys and the pancreas are transplanted from the same deceased donor during one operation. The synchronized transplant offers multiple benefits by reducing the risk of diabetic recurrence in the new kidney, improving metabolic control, and enhancing survival rates.
- Pancreas after a kidney transplant (PAK), in some cases, patients may have already received a kidney transplant earlier, either from a living or deceased donor. If their diabetes continues to progress or remains uncontrolled, they may undergo a pancreas transplant later. This approach allows the stabilization of kidney function before correcting the diabetic condition. The pancreas, after a kidney transplant, has the advantage of allowing flexibility in timing and donor selection.
- Pancreas transplant after living donor kidney transplant (PLDK) is a variation of PAK performed when the patient first receives a kidney from a living donor and later receives a diseased donor pancreas. This combination helps avoid long-term dialysis and offers an improved quality of life while waiting for a suitable pancreas.
- Segmental pancreas transplant. In rare situations, a segment of the donor pancreas is transplanted and inserted into the whole organ. This is a technique considered in highly selected cases.
| Procedure Name | Pancreas Transplant |
|---|---|
| Type of Surgery | Major surgery |
| Type of Anesthesia | General Anesthesia |
| Procedure Duration | 3-8 hours, especially when being transplanted with a kidney |
| Recovery Duration | 6-10 days hospital stay, Full recovery about 6 months |
Pancreas Transplant: Pre-Op & Post-Op Care
The procedure for Pancreatic Transplant surgery is divided into three different phases: pre-operative phase, intra-operative phase, and post-operative phase. These phases are designed to make sure of patient safety, accuracy of procedure, and optimal recovery. The pre-operative stage is examining the patient and making them ready for surgery, which is followed by the surgical procedure itself during the intraoperative stage, and finally the post-operative stage, where the patient returns to normal activities after surgery becomes an essential objective.
Before the Pancreas Transplant Surgery
This phase of surgery is one of the most critical stages of the process, which determines the success of the procedure. This phase involves a series of medical, psychological, and surgical examinations with a focus on ensuring that the transplantation can be handled and thus can handle the lifelong complications of the surgery process.
The Patients considered for pancreatic transplant surgery are typically patients with type 1 diabetes mellitus who have developed severe other diseases, like kidney failure, neuropathy, and retinopathy. In some cases, patients with type 2 diabetes may also be considered.
Complete check-up of the patient’s diabetes history, cardiovascular status, and presence of any other disease conditions.
Lab evaluations include a complete blood count, liver and kidney function tests, blood glucose tests, HbA1c, and immune compatibility testing.
Cardiac tests, like echocardiography or angiography, as diabetic patients who are at higher risk of cardiovascular problems.
Psychological examination to examine how ready the patient is, compliance, and understanding of the post-transplant responsibilities.
Donors are of two types: deceased and living. Living donors provide a part of their pancreas. In deceased donor cases, the organs are chosen for transplantation based on compatibility with the blood group, body size, and cross-match results. The pancreas must be healthy with no infiltration or fibrosis and must always be stored under sterile conditions.
How successful the transplantation of the pancreas is depends on immunological matching between donor and recipient, and the tests include
ABO blood group matching, Human Leukocyte antigen matching, and cross-match testing, so the recipient’s body does not reject the organ received from the donor.
Once a suitable organ becomes available, the recipient is admitted immediately. Pre-operation stage includes fasting for several hours, IV line insertion, starting antibiotics, blood sugar control, and giving patients immunosuppressive drugs to prevent early rejection.
Intra-Op – The Pancreatic Transplant Surgery Process
The Intraoperative phase of pancreatic transplant surgery is based on a technical process, a complex and lengthy procedure, lasting anywhere between 4 to 8 hours, depending on whether it is a Pancreas transplant alone, or is pancreas after a kidney transplant (PAK).
The patient is placed under general anesthesia and positioned supine on an operating table. Continuous monitoring of vital parameters like heart rate, blood pressure, oxygen saturation, and urine output is vital throughout the procedure.
A midline abdominal incision, or lower transverse cut, is made to expose the abdominal cavity of the recipient.
The donor pancreas is received with an attached segment of the duodenum, and is often preserved in the cold preservation solution until transplantation.
In a combined Simultaneous pancreas-kidney transplant (SPK), the kidney is transplanted first to re-establish the function of the kidney.
The surgeon connects the donor pancreatic artery and vein to the recipient blood vessels. Commonly, the donor portal vein is attached to the recipient iliac vein, and the donor’s artery is connected to the recipient’s iliac artery or any other suitable branch. These connections restore the blood flow to the organ.
The pancreas produces major digestive enzymes and must be safely drained, for which two methods are used. Bladder drainage where the donor duodenum is connected to the recipient’s urinary bladder. This allows easy monitoring of the pancreatic enzyme levels in urine, helping in detecting rejection early. Enteric drainage is another technique where the donor duodenum is connected to a loop of the recipient’s small intestine. This is now more commonly performed as it maintains normal physiology and decreases the amount of urinary complications.
Once all vascular connections are made, the clamps are released, which allows the blood flow to the pancreas. The graft is observed for any color change or turgor, which indicates good perfusion. Any bleeding is controlled, and the surgical site is irrigated.
After verification of hemostasis and making sure that the graft is well-perfused, the abdominal cuts are closed out in layers. Drains may be placed near the graft to remove excess fluid and monitor any leaks or bleeding.
Post-Op – After the Pancreas Transplant Surgery
The post-operative phase involves long-term monitoring and management of the patient’s health to make sure that the transplanted pancreas is working normally to prevent rejection and function normally.
The patient is shifted to the intensive care unit for close observation. Vital signs, volume of urine excreted, and glucose levels in blood are being monitored continuously.
Blood glucose monitoring involves testing glucose levels, and if they are found to be normal, that means the transplanted pancreas is working normally.
Fluid and electrolyte balance is carefully maintained to prevent dehydration and overload.
Pain management and infection control are given top priority.
Medications, especially immunosuppressive drugs, are scheduled throughout to prevent any chance of rejection of the graft.
Complications are monitored during this stage. Some of the common complications include Thrombosis of graft vessels, bleeding or infection, pancreatitis, anastomotic leaks, and any episodes of graft rejection.
Ultrasound and computed tomography may be performed to evaluate the perfusion of the graft and detect the above-mentioned complications early so that they can be managed.
Long-term post-operative management includes shifting of patient from the ICU with modifications in diet, physical rehabilitation, follow-up, and prevention of infection.
A transplanted pancreas works for 10 years or more with proper care. Long-term survival depends on adherence to medicines and modifications in lifestyle.
Benefits of Pancreas Transplant at Yashoda Hospitals
- Restoration of normal insulin production
- Freedom from insulin therapy
- Better blood sugar control
- Prevention of diabetic complications
- Improved kidney function (in Simultaneous pancreas-kidney transplant (SPK))
- Enhanced quality of life
- Improved cardiovascular health
- Increased longevity
- Psychological and emotional benefits
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