Organ Transplants | Pancreas Transplant

The pancreas, located below your liver and under your stomach, is about 7 inches long and weighs about 3.5 ounces. It has two main functions:

A pancreas transplant can help manage the organ damage that may result from insulin-dependent diabetes. A successful pancreas transplant will eliminate the need for insulin injections, reduce or eliminate dietary and activity restrictions due to diabetes and decrease or eliminate the risk of severe low blood sugar reactions.

Patients with type 1 diabetes may be evaluated for pancreas and pancreas-kidney transplants. Patients with type 2 diabetics are less likely to be candidates for a pancreas transplant because they may be insulin-resistant and unable to reap the benefits of a pancreas transplant.

Although type 1 diabetes can develop at any age, type 1 diabetes most commonly occurs in children and young adults, which is why it was previously called juvenile diabetes. It is considered an autoimmune disease, meaning that the body's own immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Patients with type 1 diabetes have very little or no insulin and need to take insulin everyday.

Type 2 diabetes is the most common form of the condition. It usually is diagnosed in adults over the age of 40. About 80 percent of those with type 2 diabetes are overweight. Because of the increase in obesity, type 2 diabetes is being diagnosed at younger ages and more frequently in children. Initially in type 2 diabetes, insulin is produced, but the insulin cannot function properly, which leads to a condition called insulin resistance. Most people with type 2 diabetes suffer from both insulin resistance and decreased insulin production.

If you became insulin dependent at the age of 18 or older, we will need results from a blood test to indicate your levels of C-peptide, a product of insulin production.

To complete the evaluation, we also need results from a number of other tests, including:

Any changes in your health will be reviewed by our selection committee, which includes all transplant doctors and nurses. Your transplant eligibility will be reassessed continuously and further medical tests may be required.

Transplant candidacy also relies on adequate insurance coverage for your surgery as well as care and medications after discharge. Before a final decision is made, we will request verification of coverage from your insurance provider.

The usual treatment for diabetes is to take insulin to replace what the pancreas is not producing. Careful monitoring of blood sugar levels to achieve the appropriate insulin dosage may prevent or slow many diabetic complications.

Another treatment is to restore insulin production by transplanting a healthy pancreas. Pancreas transplants usually are not recommended for diabetics who are managing their disease through other means.

A pancreas transplant is major surgery with the all the risks and recovery issues of other open surgeries. With all transplants, there is a risk of organ rejection. To prevent rejection, you will have to take powerful antirejection medications for the rest of your life. These medications have a number of side effects including making the transplant recipient more susceptible to many illnesses.

In addition, the shortage of available donor pancreases makes transplants difficult. Wait time for a solitary pancreas transplant is about a year to 18 months for all blood types. Our waiting time for a simultaneous pancreas-kidney transplant for those with blood types O and B is about 2½ to 3½ years. Estimated waiting time for a kidney alone is about five years. For those with blood types A and AB, the average waiting time for a combined kidney and pancreas transplant is about 1½ to 2½ years. The estimated waiting time for a kidney alone is about three years.

One of the most serious complications of type 1 diabetes is end-stage renal disease (ESRD) or end-stage kidney disease, which may require a kidney transplant. A kidney transplant without a pancreas transplant means you will have to take antirejection medication for the kidney and continue to take insulin.

The possibility of diabetes damaging the new kidney and other organs also remains. Successful combined pancreas-kidney transplants prevent diabetic damage in newly transplanted kidneys as well as eliminate the need for insulin therapy. In the best case scenario, a patient will receive a new kidney and pancreas from the same donor.

By the time diabetes causes end-stage kidney failure, other complications of the disease often are advanced. Improvements in surgical techniques and immunosuppressive medications make it possible to perform solitary pancreas transplants for diabetic patients who don't yet have serious kidney disease but who have problems maintaining normal blood sugar and insulin levels.

Results of solitary pancreas transplants are achieving the excellent results of simultaneous pancreas-kidney transplants.

Advances the prevention of organ rejection also make it possible to perform solitary pancreas transplants in patients who have had successful kidney transplants.

Kidneys and pancreases may be provided by a cadaveric donor, or a person who is brain dead. Kidneys also may be provided by a living donor who donates one of his or her kidneys and survives on the remaining kidney.

We encourage candidates to accept kidney transplants from living donors if a donor is available. A cadaveric pancreas transplant may follow the kidney transplant six months to a year later. While live kidney donors don't have to be blood relatives, they must have a blood type compatible with yours. Donors may be excluded for high blood pressure, obesity, diabetes or history of cancer.

Spread throughout the pancreas are clusters of cells called the islets of Langerhans. Islets are made up of two types of cells -- the alpha cells, which make glucagon, a hormone that raises the level of glucose or sugar in the blood and the beta cells, which make insulin.

In a minimally invasive procedure, insulin-producing beta cells are isolated from a donor pancreas, then injected through the skin into the portal vein of your liver, where they attach to new blood vessels and release insulin. For an average-size person, a typical transplant requires about 1 million islets, equal to two donor organs.

The beta cells then migrate to the sinusoids of the liver, where they resume their normal function. Previous attempts at islet cell transplants, including several at UCSF Medical Center, were hampered by the toxic effects of immunosuppressive drugs on the islet cells and by graft rejection. Less toxic immunosuppressive medications available now have improved the effectiveness of pancreatic islet transplantation in several trials. Based on these recent successes, UCSF began a trial of pancreatic islet transplantation in 2001.