Are you someone who injects insulin every day, checks your blood sugar levels several times a day, and thinks a lot about what you eat and drink? You probably know how challenging it is to live with Type 1 diabetes, especially. So, can you even imagine a life without these injections, diet, and constant checkups? Well, the pancreas transplant surgery we are talking about today is an answer to that question to some extent. Although this is a bit of a complicated topic, let's talk about it simply, in a way that you can understand.
Simply put, what is a pancreas transplant?
A pancreas transplant is a surgical procedure in which a healthy pancreas from a deceased donor is transplanted to replace your diseased, malfunctioning pancreas.
Imagine, inside our body, behind the stomach, there is an organ called the pancreas. One of its main functions is to produce a hormone called insulin. This insulin helps the body's cells absorb the sugar, or glucose, found in the food we eat and use it for energy.
Now, what happens to a person with Type 1 diabetes is that their own immune system mistakenly destroys the insulin-producing cells in the pancreas. Then insulin production is greatly reduced, or completely absent. That's why they have to inject insulin externally.
Who really needs this surgery?
This surgery is not for everyone with diabetes. It is mainly aimed at people with type 1 diabetes who are in a severe state and have difficulty controlling their blood sugar levels. Doctors consider this option for people whose blood sugar levels are not well controlled even with regular insulin therapy and who are experiencing frequent and severe complications.
One of the most serious complications of type 1 diabetes is kidney damage. When blood sugar levels remain high and uncontrolled for a long time, it can damage the kidneys and lead to kidney failure. In fact, many people who qualify for a pancreas transplant already have kidney failure.
Therefore, this surgery is often not done alone. A kidney transplant is performed at the same time as the pancreas transplant. This is called a 'Simultaneous Pancreas-Kidney (SPK) transplant'.
After a healthy pancreas is transplanted, it begins to produce insulin naturally, which means that a person with diabetes has the opportunity to become insulin independent.
What are the benefits of a pancreas transplant?
This is the closest we can get to a cure for type 1 diabetes. After this surgery, you will have the opportunity to live a better, longer life. Imagine how much you would be free from these things?
- Checking your blood sugar every day: You can get rid of having to prick your finger several times a day to take blood and check your sugar.
- Insulin injections: You can get rid of the responsibility of having to get your injections on time every day.
- Strict diet control: You don't have to worry about everything you eat. You can eat normally.
- Risk of diabetes complications: Long-term damage caused by diabetes to the eyes, kidneys, nerves, and heart can be prevented.
What happens before the surgery? How do I prepare?
If your doctor thinks you might be a good candidate for this surgery, you will be referred to a specialist team (transplant team). You will then undergo a very extensive examination. This will check whether you are physically and mentally fit for such a major operation.
| Test / Evaluation | What do you expect from it? |
|---|---|
| Blood and urine tests | Check the function of other organs, such as your kidneys and liver, and your overall health. |
| Complete physical examination | Make sure there are no other medical conditions that could affect the surgery. |
| Immunological studies | Find out your tissue type and help find the best match for you. |
| Imaging tests | Perform scans such as ultrasound and MRI to assess the condition of your body's internal organs and plan surgery. |
| Psychological evaluation | Make sure you have a good understanding of the seriousness of this surgery, the risks, and the lifelong precautions you need to follow after the surgery. |
If you pass all of these, the medical team will put you on the national waiting list for a pancreas. While on this list, you may have to wait months, or even years, for a matching organ to become available.
What should you do when you are on the waiting list?
This time is very important. You need to be as healthy as possible because you need to be ready for surgery as soon as you get the call that a matching organ has been found.
- Medical appointments: Be sure to go to every clinic or test that has been prescribed for you.
- Bad habits: If you smoke, stop it completely. Limit alcohol.
- Exercise: Exercise according to your doctor's instructions, as appropriate for your health condition.
- Medication: Take all prescribed medications on time.
- Health changes: If you experience any changes in your health (fever, cough, new pain), inform your medical team immediately.
Also, you always have to be prepared because a call could come at any time saying that a matching organ has been found.
- Keep your phone with you at all times, in working order.
- Prepare a bag with the clothes and essentials you need to go to the hospital.
- Tell your family, friends, and workplace about this so they can help you if you have to leave in an emergency.
How is the surgery performed?
A pancreas transplant operation usually takes between 3 and 5 hours . If a kidney is also transplanted, the time can be about twice that.
You will be under general anesthesia throughout the surgery. This means you will not feel anything and will be completely asleep. The surgeon will perform the surgery as follows:
1. Making an incision: A long incision is made in your abdomen, from just below your breastbone to just below your navel. Sometimes additional incisions may be made in the area between your stomach and thighs.
2. Organ transplant: A healthy pancreas taken from a donor is transplanted into the right side of your abdomen.
3. Connection: The new pancreas is connected to nearby blood vessels and your small intestine.
4. Old pancreas: The most important thing is that your old, diseased pancreas is not removed from your body. The reason it is left in place is because it still produces digestive juices.
5. Incision closure: Finally, the incisions are closed with stitches.
What happens after the surgery?
If the surgery is successful, the new transplanted pancreas will begin producing insulin almost immediately.
After surgery, you will be transferred to a special unit (often an intensive care unit), where the medical team will monitor you very closely.
- Are there any possible complications from the surgery?
- Are there any signs of organ rejection?
- Will you recover after anesthesia?
During this time, you will have many machines and tubes connected to your body. They will give you fluids and nutrients, oxygen, and painkillers. You will also have a tube to drain urine and another tube to drain blood and fluid from the surgery site. Don't be scared by these things, they are all done to help you recover quickly.
If there are no complications, you will be transferred to a general transplant ward in a few days. You will usually have to stay in the hospital for two to three weeks after a pancreas transplant.
What are the risks and complications of this surgery?
Because this is a very complex surgery, there may be some risks and complications.
- Blood clots: There is a risk of blood clots forming in the blood vessels after surgery.
- Infection: As with any surgery, there is a risk of infection.
- Organ rejection: This is the biggest challenge. Simply put, your body's immune system recognizes the new pancreas as "foreign" and tries to attack it.
- Pancreatitis: The new transplanted pancreas may become swollen or inflamed.
The medical team is doing its best to manage and prevent these risks.
How long will it take to get back to normal life?
It can take up to six months to fully recover. This varies from person to person. The general recovery process is as follows:
- Stitch removal: The stitches will be removed in about three weeks.
- Medical tests: During the first few months, you will need to visit the hospital frequently for blood tests and other tests. These will check whether the new organ is working well and whether there are any signs of rejection.
- Exercise: After about six weeks, you can start light exercise. Things like lifting weights should not be done for several months.
- Work: You will have to take a few months off to go to work.
Your medical team will give you separate advice on all of this.
Is there any medication that I have to take for the rest of my life?
Yes. This is very important. After the surgery, you will have to take medications called immunosuppressants for the rest of your life.
These medications work by suppressing your body's immune system from attacking (rejecting) the new pancreas. These medications may have some side effects. However, do not stop taking these medications or change the dosage without first talking to your doctor. Doing so may cause your body to reject the new organ and the surgery to fail.
What are the symptoms that require an urgent visit to a doctor?
Your medical team will give you instructions to continue following, but if you develop any of the following signs of infection or organ rejection, you should seek medical advice immediately.
| Symptoms to watch out for | Description |
|---|---|
| Fever and chills | Having a fever of more than 37 degrees Celsius (100 Fahrenheit). |
| Pain | Pain or tenderness in the area of the newly transplanted pancreas (right side of the abdomen). |
| Body aches | Unusual body aches, including headaches. |
| Nausea or vomiting | Persistent nausea or vomiting. |
| Swelling or weight gain | Body swelling or sudden weight gain. |
| Decreased urination | Less urine output than usual. |
Ultimately, a pancreas transplant is a very important treatment option for severe type 1 diabetes. Although it is a complex, risky surgery, if successful, it can lead to a more independent life, free from insulin injections, diabetes complications, and complications. Before making a decision, it is important to discuss this with your doctor and understand both the pros and cons.
Take-Home Message
- A pancreas transplant is a major surgery performed primarily for severe, uncontrolled type 1 diabetes.
- This allows you to be free from insulin injections, constant blood tests, and strict diet control.
- This is often done in conjunction with a kidney transplant.
- After surgery, you will need to take immunosuppressants for the rest of your life to prevent your body from rejecting the new organ.
- This is a long journey from evaluation to full recovery, and it requires patience, dedication, and a close relationship with the medical team.
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