If you have type 1 diabetes, it might be hard to imagine life without insulin, but it’s possible for some patients with a novel treatment option: a pancreatic transplant. A successful pancreatic transplant gives patients freedom from insulin and intensive glucose monitoring.
“It’s an excellent option for patients who have failed intensive medical therapy for type 1 diabetes,” says transplant surgeon John Rabets, MD. “It’s a good option for people who are poorly controlled diabetics that can’t be controlled because of labile hyperglycemic or hypoglycemic episodes,” he adds.
The first pancreas transplant occurred in 1966, but it wasn’t until the mid-1990s that it became a more universally accepted option. Since then, Cleveland Clinic surgeons have performed more than 300 pancreas transplants — some including simultaneous kidney transplants.
Dr. Rabets, who is part of a team of four Cleveland Clinic surgeons who performs the operation, says that the goal of the surgery is to establish a “euglycemic state,” or a normal concentration of glucose in the blood.
“Surgery allows patients to maintain their blood sugars within a normal range without intensive monitoring or insulin, which can be quite liberating to a life-long diabetic,” Dr. Rabets says.
So how does a diabetic know when a pancreas transplant may be in order? Dr. Rabets says to watch for the following signs to be consistently present, despite insulin therapies:
- Passing out (from unrecognized hypoglycemia)
- Multiple visits to the ER for hyper- or hypoglycemia
- The requirement that other caregivers be constantly present in case of an emergency
- Unaceptable Hemoglobin A1c levels despite optimal medical management
“The operation is for people that cannot control their diabetes despite the best medical therapies available,” he said, noting that transplants are only for Type 1 diabetics, whose bodies don’t make insulin.
“These are typically patients that develop diabetes at a young age who no longer produce Insulin. The pancreas is the source of Insulin. With the transplant, now they have an organ that produces a normal amount of Insulin and returns the patient to a euglycemic state.”
Nationally, there are roughly 1,200 people on the wait list for a pancreas transplant. Another 2,200 people are waiting for a combined kidney/pancreas operation.
As with other transplants, patients need a matching donor of the same blood type. In addition, something called a crossmatch is done to test whether the patient has antibodies against a particular donor.
“If the crossmatch is negative — meaning there are no preformed antibodies in the recipient against that transplanted organ — and the blood type is the same, they are eligibile to receive the transplant,” Dr. Rabets says.
What to expect
For a pancreas transplant, a midline incision is made in the recipient’s abdomen, down the middle. In addition, there are three basic “hookups” to bring in arterial blood and drain venous outflow as well as digestive enzymes from the bowel.
Patients typically are up and walking a day after surgery and out of the hospital after a week or so. Their blood sugars normalize almost immediately. Normal activities usually can resume within four to six weeks.
As with any major surgery, infection is always a risk, Dr. Rabets says.
“Patients after a transplant have to be kept on immunosuppressant drugs so they don’t reject the organ,” he says. “They have to take those medications for the rest of their lives. Despite the new medical regimen, most patients much prefer this to intensive glucose monitoring and insulin,” he says.
Dr. Rabets recommends that prospective patients come in for an evaluation with a multidisciplinary team, including a surgeon, an endocrinologist and a nephrologist, as well as a social worker.
“We do a full medical evaluation to make sure that the patient is well enough for the operation and to make sure that the operation is the right thing for that patient,” he says. “Patients consistently say that their quality of life is vastly improved after a pancreatic transplant and wish they’d known about this option sooner.”
*Medicare offers coverage to patients needing pancreas-only transplantation if they meet certain criteria.
Ask the Experts: Organ Donation & Transplantation
Wednesday, April 17, 2013
12 Noon (Eastern Time)