LABORATORIO DE URGENCIAS

Pancreas Transplant in Diabetic People

Statement from the Argentine Diabetes Society - 2016

The decision to perform a pancreas transplant must be made with very strict criteria, and exclusively in people who do not achieve adequate blood sugar control despite treatment with insulin.
Pancreas transplant achieves adequate control of glucose levels in most patients; it must be taken into account that this medical procedure involves a major surgical intervention, which is not devoid of potential complications.
The pancreas of people with type 1 diabetes mellitus (previously called insulin-dependent) does not produce insulin, or it does so in minimal quantities, which are insufficient to control blood sugar (glucose) levels.
The most frequent and best developed treatment for these people is the application of insulin. “Only in a very low percentage of patients can this treatment not work properly and in these cases pancreas transplant could be considered as an alternative treatment.”
Complications arising from the transplant are related to the surgery and the medications that patients must subsequently take. In centers with extensive experience, life expectancy within one year of the transplant is greater than 90%, but there are approximately 10% of patients in whom complications can be serious and present a risk of death.

Advantages and risks

Because the body's immune system cells may reject the transplanted organ because it is considered foreign tissue, people who receive a transplant must take immunosuppressive medications that aim to lower their defenses.This treatment - which must be maintained for life - in most cases prevents the implanted pancreas from being rejected by the body, but in return it increases the risk of infections and in the long term in some people it can increase the risk of the appearance of malignant tumors. .
Pancreas transplant is not performed to avoid, in the patient with type 1 diabetes, the disorders and discomforts associated with the use of insulin, but rather it should be recommended only in cases where insulin treatment has failed, and the person with diabetes suffers. episodes of very high or very low blood glucose, without the possibility of adequately controlling them. People who are candidates for a pancreatic transplant must be selected with very rigorous criteria.

The simultaneous transplant

Diabetes can affect, especially if poorly controlled, vision, the cardiovascular system, nerves and kidneys. When a patient with diabetes needs hemodialysis due to loss of kidney function, he or she may be a candidate for a simultaneous kidney and pancreas transplant. In fact, this type of double surgery is the one that is performed most frequently, because kidney transplantation has superior results than dialysis therapy.
The immunosuppression that in itself must be administered by the kidney transplant is taken advantage of and the pancreas is also transplanted. With this treatment, it is possible to practically double the life expectancy that a patient with diabetes would have if they continued on dialysis.
Simultaneous kidney and pancreas transplantation is recommended in people with diabetes who have lost kidney function and require dialysis.
The decision to perform a pancreas transplant must be made with very strict criteria and exclusively in people who do not achieve adequate blood glucose control despite treatment with insulin.