Pancreas Transplantation
Pancreas transplantation has been used rarely in children, but it is likely to be used more often in the future. This is because more recent improvements in immunosuppressive drugs and surgical technique have provided better results with fewer risks, and pancreatic cell (islet cell) transplantation is now being done. Pancreas transplantation is performed either as a single-organ transplant or at the same time as a kidney transplant in patients with severe kidney disease.
Most children with type 1 diabetes can be treated successfully by placing devices inside their bodies that release insulin like a normal pancreas would and result in satisfactory sugar control. When patients develop severe kidney disease, pancreatic transplantation becomes a treatment choice.
Pancreatic transplantation alone is limited to a small group of patients with insulin-dependent diabetes, including patients without severe kidney disease who have difficult sugar control, patients with severe kidney disease who need a kidney transplant, and patients with severe complications of diabetes that may be reversed at least somewhat by successful pancreatic transplantation.
Pancreatic transplantation is not usually recommended for patients with a cancerous tumor, active infection, blindness, or advanced heart disease. Successful human pancreatic cell (islet) transplants are now being done and probably will be the usual treatments in the future. Until islet cell transplants become successful most of the time, whole-pancreas transplantation is still the best choice.
Different immunosuppressive drug combinations have been used with the new pancreas surviving 60% to 80% of the time after one year. The hope of pancreatic transplantation is to reverse or stop the complications of diabetes and to improve the quality of life of the patient.
SUGGESTED READING
Humar A, Kandaswamy R, Granger D, et al: Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 231:269-275, 2000.
This article summarizes the current status of pancreas transplantation.
Article and graphics adapted from O'Neill: Principles of Pediatric Surgery. © 2003, Elsevier.