Pancreas transplant: indications and contraindications
A person diagnosed with type 1 diabetes can get a pancreas transplant in the future if s/he want to improve quality of living. People with diabetes forced to maintain a diet, constantly evaluate blood sugar levels and are dependent on insulin injections. Patients older than 40 years have higher risks of developing secondary complications related to diabetes:
- kidney failure.
In case of condition worsening the only opportunity for a patient to retain their normal state is to receive the pancreas from a donor. That will return a recipient to normal life within weeks.
There are also contraindications to surgery:
- Age over 55. Most hospitals don’t operate people older than 55 years due to high risk of post-operational complications;
- Slow response. Diabetes is a fast-advancing disease, and if you consider pancreas transplant, address the issue as soon as possible;
- Non-compliance history. Patient must comply with potential risks the operation is bearing;
- Presence of 1 or more end-organ complications related to diabetes (kidney failure, heart malfunction, etc.) defines the eligibility for transplantation.
How to get a pancreas transplant?
In most countries, partial pancreas transplant living donor is either impossible or extremely complicated due to legal reasons. The common practice is that a patient receives organs from a cadaveric donor. Those are people who experienced heavy cranial or related trauma due to an accident and cannot survive. Only if brain function is lost completely and irreversible, the cause of death is certain and relatives of the donor have agreed on transplantation, the operation may commence.
Prior to the procedure, a variety of tests are carried out to ensure donor/recipient compatibility. Pancreas transplant in India is legally allowed and performed in accordance with all international protocols. For instance, Indian hospitals have JCI (Joint Commission International) and ISO (international quality standard) accreditations. These accreditations ensure high safety and quality of provided medical services.
Donor requirements are:
- Age. They must be less than 45 years old;
- Weight. A donor must weight more than 30 kg;
- Have no history of diabetes;
- Obesity is also considered a contraindication.
If a patient is planning to receive pancreas transplant it is required to stay in the country where the operation will be performed until a suitable donor is found. Hospitals won’t put a patient on the waiting list otherwise. Organs can be stored for up to 30 hours in special solution, but each passing hour decreases success rate of the operation.
Before the transplantation commences a patient must:
- Undergo full medical exam to assess their condition, including blood tests;
- Start dieting according to doctor recommendations.
Patients who receive pancreas replacement fall under one of 2 categories: those whose kidney is damaged by diabetes to the extent that it needs to be replaced, and those who only need a pancreas transplantation.
Types of pancreas transplant operation
Depending on patient’s physical condition an operation will be performed according to one of 4 scenarios:
- Simultaneous pancreas-kidney transplant (SPK). In most cases, diabetes causes malfunction and degenerative processes in patient’s kidneys. Some patients who suffer from diabetes are already on dialysis (external blood filtration). SPK increases the long-term survival rate of patients and allows them to go off the dialyis;
- Pancreas after a kidney transplant (PAK). This procedure puts a patient under more stress since s/he has to undergo two surgical invasions. For PAK operations organs can be used from two different donors. PAK operations bear less surgical complications;
- Pancreas transplant alone (PTA). In some cases when there is no malfunction in kidneys, only pancreas is transplanted;
- Kidney after pancreas (KAP) transplant. In some cases, physicians may find it viable to carry out transplantations in this order. For example, when kidneys malfunction became apparent after the pancreas transplantation.
Pancreas transplant surgery
The operation itself is extremely complex and can take up to 6 hours. A team of professional surgeons performs an operation under general anesthesia. During the operation, patient’s own kidneys and pancreas are not removed, instead, new organs are transplanted into abdominal area.
Only the best among accredited surgeons are allowed to participate in the operation. They are prepared to treat possible complications and any unsuspected developments. This is why the operation success rate is high, as doctors are prepared to react to every situation and outcome.
Still, there are some risks to the procedure, that include:
- Immune system rejecting transplanted organs and trying to get rid of them. Strict donor assigning protocols reduce the chances of this complication;
- The appearance of blood clots in the vascular system of newly transplanted organs. This risk is determined by overall health state of both the donor and the recipient;
- A temporary inflammatory reaction of the pancreas. May be caused by a vast range of factors, is usually quickly healed in intensive care unit as a part of post-operational routines.
New transplants usually start working within several hours after the operation. The pancreas normalizes blood insulin level and a patient won’t require injections anymore. Immediately after the surgery, a patient is placed into intensive care unit to stabilize their condition and give a good start for rehabilitation period.
After the patient’s condition has stabilized, s/he stays in a hospital for an average of 2 weeks to make sure their condition remains stable. During that time a patient who underwent the transplantation starts taking immunosuppressants. It is a special medicine that prevents recipient's immune system from “attacking” foreign organs. This is the only option to prevent transplant rejection, medicine intake is mandatory and cannot be skipped. Patients are also required to undergo regular medical exams to monitor their state and the state of their new organs. That ensures their safety and well-being. Recipient stays in the hospital for 1-2 months depending on their condition.
Rehabilitation includes standard routines associated with the post-operative period. A recipient will spend first few weeks in hospital. After that, additional rehabilitation measures may be required, such as low stress environment and minimal physical activity. Due to anti-rejection treatment, patient’s immune system is weakened. That bears higher infection and illness risks, may cause bone thinning, high blood pressure and other side-effects.
The outlook for patients is rather positive, as survival rates in patients that underwent SPK are:
- up to 93% within the first year;
- up to 88% within first three years;
- up to 85% within ten years after the surgery.
How much does a pancreas transplant cost?
How much is pancreas transplant is the main question among patients. The Pancreas transplant cost depends on patient’s condition, type of operation that needs to be done, donor availability, urgency, and many other factors determined by doctors. The price for pancreas transplant in Germany, Israel and the USA is 2-4 times higher than in India.
Pancreas replacement cost also depends on:
- Qualification of a doctor performing the surgery;
- Conditions and duration of stay in hospital ward;
- Medications used during postoperative period to treat complications and speed up rehabilitation processes.
Frequently asked questions
- Is type 2 diabetes curable by this procedure?
In some cases physicians may find it viable to use pancreas transplant to treat type 2 diabetes, you should contact your doctor for more details.
Note that pancreatic cancer is not treated by transplantation.
What are the benefits of the transplantation?
The procedure will boost your endurance and allow you to lead a life not dependent on insulin and blood dialysis. You will not be required to follow a strict diet and the risks of developing morbid diabetes-related organ complications will be gone.
In what way can I ensure the success of rehabilitation?
The general advice is to strictly follow your doctor’s orders. Take your immunosuppressant medicine according to the schedule, visit physicians for appointed examinations, do blood tests. Always stay conscious of your health state and notify your health service providers about any abnormalities you notice.
How to undergo pancreas transplant faster?
Submit a request on Bookimed site and our Doctor-Coordinator will contact you. We work with the best medical facilities and will help organizing the procedure in the shortest terms.