April 2019: Pancreas Transplantation - Data and Outcomes

April 2019: Pancreas Transplantation - Data and Outcomes

Contributor: Tambi Jarmi, M.D.

Diabetes is a lifelong chronic disease with the potential for significant complications; however, major advances have been made in diabetes treatments over the last decade. More people are enjoying the ability to manage diabetes through the advancements in technology and medication. Despite this, a significant number of people with diabetes still struggle with the disease. Pancreas solid organ transplantation is an option that could restore insulin production and may stop or slow the progression of diabetes complications.

Pancreas transplantation is a surgical procedure where a healthy pancreas from a deceased donor is placed into a patient with diabetes. It is recommended for patients with one or more of the following:

  • Type 1 diabetes that has not been managed with standard treatment
  • Type 2 diabetes associated with both low insulin resistance and low insulin production
  • Frequent hypoglycemia or hyperglycemia
  • Advanced kidney damage
  • Type 2 diabetes associated with both low insulin resistance and low insulin production

There are three types of pancreas transplantations:

  1. Pancreas Transplant Alone: This is recommended when people with diabetes are evaluated early on during the course of the disease and have not developed advanced kidney disease.
  2. Combined Pancreas and Kidney Transplant: This is recommended when people with diabetes are showing signs and symptoms of advanced kidney disease and/or are on dialysis.
  3. Pancreas Transplant after Kidney Transplant: This is recommended when kidney transplant recipients develop new onset of diabetes after the kidney transplant, and/or have difficulty managing their diabetes with traditional treatment.

Over the last three decades, the outcomes of pancreas transplantation have improved significantly. A successful pancreas transplantation may eliminate the need for insulin and frequent blood glucose checks. It does, however, require lifelong treatment with immunosuppressive medications. Such medications are needed to prevent a person’s immune system from rejecting the transplanted pancreas. There are some short and long-term side effects and complications related to the immunosuppressive medications; however, overall the current immunosuppressive medications are well tolerated by most. Those who are taking lifelong immunosuppressive medications are expected to live a normal life with no special need for social and public isolation. They continue to engage in their society with the emphasis on living and practicing healthy habits.

Survival after pancreas transplantation is significantly higher when compared to people with diabetes who are listed for transplant and are still waiting for an organ. The United Network for Organ Sharing (UNOS) data showed that five years’ survival of all types of pancreas transplantation is 90%. It has been shown that the gain in life expectancy is 15.7 years when combined kidney and pancreas transplant has been performed, and 17.2 years when pancreas after kidney transplant has been performed. (OPTN/SRTR 2017 Annual Data Report: Pancreas)

Pancreas transplantation may not be suitable for all people with diabetes. However, when people with diabetes meet the criteria for transplantation, the advantage of long-term survival significantly outweigh current traditional and standard medical management.

Tambi Jarmi, M.D. is a nephrologist in the Gary and Dianne McCalla Center for Transplantation and Regenerative Care at Mayo Clinic hospital in Jacksonville, Florida. He has been published in numerous peer-reviewed articles and abstracts and is certified in internal medicine and nephrology by the American Board of Internal Medicine, as a specialist in clinical hypertension by the American Society of Hypertension and is a certified transplant physician by the American Society of Transplantation.