Introduction

Transplantation of the pancreas is required for the treatment of patients with diabetes who are difficult to manage with oral medicines and insulin. It cures the diabetes but requires immunosuppressive medicines to prevent rejection of the transplanted pancreas.

Who needs a pancreas transplant?

Pancreas transplant was originally developed for the treatment of Type 1 diabetes which could not be properly managed with insulin. The disadvantage of any solid organ transplant is the need for immunosuppressive medicines to prevent rejection. These medicines have side-effects and increase the risk of infections. The benefit of the transplant should be enough to justify the risk. This is not for the average diabetic who is well managed with insulin.

Type 1 diabetics who have developed kidney failure due to the diabetes need a kidney transplant and immunosuppression anyway. They are benefited considerably if they can have a pancreas as well as kidney transplant from the same donor. Since the diabetes is also taken care of, the quality of life is much better and the transplanted kidney also works much longer.

Type 1 diabetics who have already had a kidney transplant and are on immunosuppression are candidates to have a pancreas transplant later for the same reason.

A pancreas transplant alone is indicated in patients with brittle diabetes which is very difficult to manage. These are patients who have frequent and dangerous episodes of hypoglycemia. Some of them have hypoglycemic unawareness (they have no warning symptoms like sweating, flushing and palpitations when their sugar drops and theu just pass out when the sugar levels become very low). They can sustain severe brain damage or die during these episodes. It is also indicated in patients in whom end-organ damage is progressing despite best medical management of diabetes.

Some patients with type 2 diabetes may also be candidates for a pancreas transplants. These are patients who are not overweight (BMI<28) and who have low insulin levels.

Types of Diabetes

Type 1 diabetes is usually diagnosed early in life. It is associated with damage to the beta cells in the pancreas which produce insulin. This damage may be due auto-antibodies. The insulin levels are low and the patients usually need insulin to manage the diabetes.

Type 2 diabetes develops in middle age and is usually associated with obesity and lack of exercise. The insulin production by the pancreas may be normal or even high but there is resistance of the fatty tissues to the action of the insulin. Weight reduction often improves the diabetes.