About Pancreas Transplant

A pancreas transplant is a surgical method performed to replace a pancreas that is not working correctly with a healthy pancreas from a deceased donor. Most pancreas transplants are done for patients with type I diabetes. This offers a potential cure for a patient with this condition. However, a pancreas transplant is usually reserved for patients with severe complications of diabetes because the side effects of this transplant can be significant.

Need for Pancreas Transplant

Various ailments may affect the functioning of the pancreas and may generate a need for pancreas transplants. Although the pancreas transplant offers a potential cure for patients with type I diabetes, the side effects of anti-rejection medications needed post-transplant must outweigh the benefits of getting the transplant. Usually, for a patient suffering from one or more of the below-mentioned conditions, a pancreas transplant is considered a viable option. Some of the similar conditions are listed below:

• Type I diabetes which is not controlled with regular treatment
• Type II diabetes associated with both low insulin production and low insulin resistance
• Very poor blood sugar control
• Frequent severe insulin reactions
• Hypoglycaemia unawareness
• Severe kidney damage

Type of Pancreas Transplant

There are different ways in which pancreas transplant is performed depending upon the situation and conditions from which patient is suffering. Below are some of the conditions which may require you to go for pancreatic transplant:

Pancreatic transplant alone: Patients of diabetes and early or no kidney disease may be a candidate of pancreas transplant alone.

Combined kidney-pancreas transplant: Surgeons may often consider performing kidney-pancreas transplants for patients with diabetes who have or are at high risk of kidney failure. Most pancreas transplants are performed at the same time as a kidney transplant. The main goal of this approach is to give the patient a healthy pancreas and kidney that are not likely to contribute to diabetes-related kidney damage in the future.

Pancreas-after-kidney transplant For patients waiting since long for both a donor pancreas and kidney to become available, a kidney transplant may be suggested first if a living- or deceased-donor kidney becomes available. After your kidney transplant is done, you'll receive a pancreas transplant once a donor pancreas becomes available.

Pancreatic islet cell transplant: During this transplant procedure, insulin-producing cells (islet cells) taken from a donor's pancreas and injected into a vein that takes blood to the liver. More than one injection of transplanted islet cells may be needed.

Waiting Period

Sometimes, it can be challenging to find a donor within a short period. Pancreas is usually taken from a person who has been declared as brain-dead but remains on a life-support system. The donor needs to meet the transplant criteria like being healthy and being of a specific age. The donor’s organ also needs to match the recipient immunologically with the recipient’s body. This is crucial to reduce the risk of organ rejection.

Sometimes, the pancreas is taken from a living donor. This usually happens when the transplant recipient can find a donor who is a twin or a close relative. In such cases, donors give a part of their pancreas and not the whole organ.

While you are on a waiting list to find a suitable donor, you have to take few adequate measures to take care of yourself by practicing:

• Regularly visiting the doctor for check-ups and follow-ups.
• Have a healthy balanced diet.
• Take all prescribed medicine on time.
• Indulge in some form of physical activity as per the doctor’s recommendation
• Avoid smoking and consuming alcohol.

Pre-pancreas transplant evaluation

Before undergoing this procedure, you may need to undergo evaluation, which includes:

General health exam: This consists of a physical examination and cancer screening tests to evaluate your overall health.

Blood tests: You may need to undergo different blood tests to know about gene compatibility.

Tissue typing: It includes series of blood tests to evaluate the compatibility or closeness of tissue between the organ donor and recipient.

Other blood tests: There are series of tests that will be done to detect various substances in the blood and to evaluate your overall health. These might be done to screen you for any infectious diseases like HIV, to check your organ function, etc.

Imaging tests: Various tests like computerised tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may be recommended to look for any abnormality in the organs.

Echocardiogram: In this test, a probe is passed over your chest, and through this probe, sound waves will bounce back to generate a picture of the heart muscles. This helps the doctor in identifying the abnormality.

Cath study: This test is done to check the pressure in the heart. The catheter is placed into the vein in the groin or neck after numbing the area. This helps in measuring the pressure levels in the heart chambers and the main blood vessels.

Social and psychological evaluation: These evaluations include various measures to assess your stress, financial issues, and support by friends and family.

The Pancreas Transplant process

Complications of a pancreas transplant

As with every surgery, the risk of complications is there, and a pancreas transplant is no exception. However, it is not always mandatory that a patient develops these complications, but it is good to be aware of them. Below are some of the common complications linked with pancreas transplant:

• Rejection: Rejection is the major complication that arises after transplant surgery. However, after taking all the precautions and matching the donor organ in the best possible way, the chances of pancreas rejection are notably less. Therefore, it is recommended to get in touch with your doctor if you observe any of the following symptoms:
• Fever
• Nausea and vomiting
• Reduction in the quantity of urine
• Painful urination
• Blood clot: Formation of a blood clot in the blood vessels supplying the donor pancreas are some of the common complications experienced.
• Pancreatitis: There is an inflammation of the pancreas experienced by the patient shortly after the transplantation process.
• Infection: Due to a compromised immune system, your doctor may prescribe antifungal, antibacterial, and antiviral medicines to reduce the infection risk.
• Excessive sugar in the blood (hyperglycemia)
• Other metabolic problems
• Urinary complications such as urine leakage or urinary tract infection
• Failure of the donated pancreas

Post-Pancreas Transplant Procedure

After the surgery is completed, patients are taken to a recovery room for few hours, where they will be under observation. Once your doctor feels you are in stable condition, you will be shifted to the intensive care unit (ICU), where you will be observed closely, and your vitals will be monitored. The doctors will also check that other organs like the liver, lungs, and circulatory system are all working. Anti-rejection medicines will be administered and closely watched to ensure that the patients get the right dose and mix the right medication. When the doctor feels you are stable, you will be shifted to a normal ward. Gradually, the patient will be able to move and walk around for a long duration. The doctor will then teach you how to take care of yourself when you go home.

Life after Pancreas Transplant

A Pancreas transplant can significantly improve the quality of life of the patients. However, there are certain practices and measures that you need to follow to live a normal life.

• Regular follow-ups: You may have to have frequent follow up with your doctor for the initial few months after the transplant. They will keep a check on the body's response to transplant and any complications which may arise.
• Immunosuppressants: As our body tends to reject the foreign body or object. You may have to take immunosuppressant medicines to avoid the possibility of rejection.
• Hygiene and lifestyle: Practising good hygiene and staying active is an excellent contributory factor for recovery. Live a healthy lifestyle by engaging in any form of physical activity, eating a balanced diet, avoiding smoking, etc.

Success rate and life expectancy of a Pancreas transplant

With progress in medicine, the life expectancy of patients undergoing pancreas transplants is also progressing. In comparison to the last decade, the life expectancy of patients has improved.

Life expectancy

• Increased lifespan of 1 year: 95%
• Increased lifespan 5 years: 88%

Tips for lifestyle modifications

Some lifestyle modifications can help you in preventing the conditions which may generate a need for pancreas transplant. Below are some of the lifestyle modifications that you may need to practise:

• Avoid smoking: Smoking is a risk factor for various health conditions like pancreatic cancer, and quitting smoking can help in lowering the risk.
• Manage weight: Being obese or overweight leads to many lifestyle diseases like diabetes, etc. Indulge in some form of physical activity like exercising, yoga, etc., to keep your body fit.
• Diet: People eating a diet high in green vegetables, fresh fruits, and whole grains and low in sugar drinks, processed food, and red processed meats probably have a lower risk of lifestyle disease.
• Alcohol: Excessive intake of alcohol has been linked to a condition like chronic pancreatitis. It is recommended to quit or limit alcohol consumption.

Choosing the ideal Pancreas Transplant center

It is essential to learn about different transplant hospitals and centers before finalizing the one. Here are few things to keep in mind while choosing a transplant hospital/center:

• Consult more than one doctor and talk to patients who have undergone pancreas transplants in the hospital and know about their experience.
• Whether the center/hospital has expertise in living or deceased donor transplants.
• Reputation of hospital/center, and its mortality rate for transplant patients.
• If the hospital/center is covered under your insurance policy.
• Total-experience the hospital/center hold in dealing with transplant cases.

Cost analysis of Pancreas Transplant

Living with a disease that badly affects your life is an extremely painful experience both for the patient and his family. Getting a Pancreas transplant can certainly improve the quality of life of the patient. The average cost of Pancreas transplants in India varies between 15 lakh approximately. It is crucial to check with the insurance company whether the transplant cost is covered in your plan. Various factors that will affect the cost are:

• Hospital infrastructure and location
• Length of stay in hospital
• Expertise of surgeons, their team, and use of advanced technology
• Any health complications
• Recovery and rehabilitation
• Post-transplant medications

A patient who travels from home to hospitals for transplant also needs to keep the cost of staying near the new city's hospital. The cost of staying also adds up over the course of a few months.