Our dedicated transplant team is committed to guiding you safely through the transplant process. Our goal is to make you insulin-free and non-diabetic. We will take the time to explain to you and your family the various options available for your pancreas transplant.
Diabetes mellitus (DM) affects more than 30 million people in the United States. About 5 to 10 percent of them have type 1(early-onset) diabetes; the majority has type 2 (late onset) diabetes. All patients with type 1 diabetes mellitus are insulindependent, and the number of patients with type 2 diabetes mellitus requiring insulin continues to increase. In general, patients on insulin are potential candidates for pancreas transplantation.
The secondary complications of diabetes mellitus affect blood vessels, eyes, nerves and kidneys. As a result, diabetes mellitus is now the leading cause of kidney failure, blindness and limb amputations in the U.S. and is one of the most common causes of heart attacks and strokes. Diabetes mellitus not only reduces quality of life, but also decreases life expectancy. However, research over the past 20 years has clearly shown that the effects of diabetes can be diminished or prevented by good blood glucose control.
Three ways to control blood glucose levels
The discovery of insulin in 1921 led to a dramatic improvement in the lives of patients with diabetes. Since that time, major improvements in insulin therapy have been made including long-lasting forms of insulin, insulin pumps and continuous glucose monitors. We work closely with the Joslin Diabetes Center at Upstate Medical University, a well recognized treatment center for diabetic care. Yet, despite the best of care, the various forms of insulin therapy do not consistently produce normal blood sugar levels and do not prevent the development of the diabetic complications of diabetes mellitus. Therefore, patients on insulin may still develop severe organ damage from diabetes or have life-threatening low blood sugar events (hypoglycemia). In fact, hypoglycemic unawareness, the patient’s inability to sense very low blood sugar levels, is a life-threatening complication of intensified insulin therapy and has been associated with an annual mortality rate of 2 to 8 percent.Patients with hypoglycemic episodes or hypoglycemic unawareness may benefit the most from pancreas or islet transplantation.
Pancreas transplantation is the only method that can offer normal blood sugar control long-term because it replaces the insulin secreting beta cells found in the pancreatic islets.
The first pancreas transplant was performed in 1966. Since then, over 30,000 pancreas transplants have been performed in the U.S. alone. Patients have been free of insulin for more than 10, 20 and 30 years following a successful pancreas transplant and this number continues to grow. Most pancreas organs for transplant are obtained from deceased donors. On rare occasions living donors can be used.
A successful pancreas transplant leads almost immediately to insulin independence with normalization of hemoglobin A1C levels. It can also stop or even reverse some of the secondary diabetic complications. As a result, the patient’s quality of life is greatly improved, multiple daily blood sugar measurements and insulin injections are no longer required and there are no more hypoglycemic episodes.Pancreas transplants are offered to patients with type 1 diabetes and to patients with insulin-dependent type 2 diabetes if they are not overweight. There are three types of pancreas transplants (SPK, PAK and PTA).
Patients with type 1 diabetes who have severe, life-threatening hypoglycemic reactions or reactions that occur at night without symptoms are potential candidates for islet transplantation.
In this procedure, deceased donor pancreases are specially processed to separate the small islets that secrete insulin from the remaining pancreatic tissue. The islets are then injected into the recipient’s liver where they reside and function. Islet transplantation does not return blood sugar levels to normal as effectively as pancreas transplants and the long-term outcome is less favorable than that of pancreas transplants.
However, successful islet transplants may prevent hypoglycemic reactions for years.
Islet transplantation is not covered by Medicare/Medicaid nor by most private insurance companies. Due to the better long-term outcome with pancreas transplants, the Upstate Transplant team recommends pancreas transplantation primarily to patients with low surgical risk and islet transplantation to patients with high surgical risk.We are exploring new research options and medical advancements in islet transplantation to prolong islet survival.