Transplanting the Whole Pancreas
Anne L. Peters, MD, CDE: Hi. I am Dr. Anne Peters from the University of Southern California, speaking to you today from the American Diabetes Association (ADA) annual meetings that are being held in Chicago, Illinois. With me is Dr. Michael Rickels, Medical Director of the Pancreatic Islet Cell Transplant Program at the Hospital of the University of Pennsylvania in Philadelphia.
We are going to focus on transplants -- whole organ and islet cell transplants. What do I need to know as a practicing clinician about transplantation in type 1 diabetes?
Michael R. Rickels, MD: Whole organ transplantation involving the pancreas is currently approved as a treatment for type 1 diabetes. Because the whole organ is transplanted and it has a complex blood vessel supply, it has to be transplanted along with part of the small intestine and requires an extensive operation that precludes its use from being widespread. For that reason, the most common indication for a whole pancreas transplant is in conjunction with a kidney transplant in a patient with type 1 diabetes who has diabetic nephropathy and needs a kidney.
Dr. Peters: From the universe of patients who need kidney transplants, would you send for that procedure? I have many more patients having kidney transplants than kidney/pancreas transplants.
Dr. Rickels: We think about the addition of the pancreas at the time of kidney transplant in any patient with type 1 diabetes who requires a deceased-donor renal transplant. The outcomes with living-donor renal transplant are good enough that it doesn't add much benefit for their long-term survival to wait for a simultaneous pancreas and kidney. If a patient can have a living-donor transplant, receiving it sooner and limiting the time on dialysis is the top priority.
In patients who may not have access to a living-donor kidney, and if they are a suitable surgical candidate to withstand the operation, then we recommend considering simultaneous pancreas and kidney transplant, which has been shown to protect the transplanted kidney from recurrent diabetic neuropathy, and it also eliminates (in most cases) the need for ongoing insulin treatment and further progression of diabetes complications.
Dr. Peters: Does the transplanted pancreas continue to function over the long term, or does it stop functioning?
Dr. Rickels: Currently, a transplanted pancreas can function for more than a decade, and the years are continuing to count. After 3 years, about 80% of the pancreases are continuing to function from transplantation, but in some cases, pancreases continue to function for a very long period of time.
Medscape Diabetes © 2013
Cite this: Transplant Options for Patients With Type 1 Diabetes - Medscape - Jun 28, 2013.