The Pancreas

The pancreas has two main functions for your body: creating hormones to regulate your blood sugar levels and producing chemicals to help with digestion. The pancreas is a long, tapering organ located across the back of the abdomen, behind your stomach.

Pancreas transplant facts

When a new pancreas is transplanted, the old one is not usually removed. It is left in place to continue performing some digestive function
The majority of pancreas transplantations are simultaneous kidney - pancreas transplantations
It is possible to live without a pancreas if you take insulin and enzyme supplements
Almost all pancreas transplants are done to treat cases of type 1 diabetes

Common reasons for transplantation

In the majority of cases, pancreatic transplants are done for patients with type 1 diabetes with end-stage kidney failure. However, this is not a routine treatment for diabetes.

A transplant is usually only recommended for people who fail to respond to insulin treatment. This usually means they have developed complications or have a high risk of developing them in future.

For example, a transplant may be recommended if:

  • you have kidney disease, which can lead to kidney failure
  • you have frequent and severe episodes of hypoglycaemia (where your blood glucose levels drop to dangerously low levels causing symptoms such as dizziness and mental confusion)

How it works

Your pancreas plays a part in your body's digestive system and produces several important hormones.

When your body senses food in the stomach, your nerves send signals to the pancreas to tell it to produce more digestive enzymes (chemicals) in the pancreatic juice. Inside the pancreas, acinar cells respond by increasing their production of enzymes and this is passed through the duct into the duodenum (the first part of your gut) where food begins to be broken down.

Your pancreas is also carefully monitoring the level of glucose (sugar) in your blood and keeping it balanced. Glucose is a form of energy taken from your blood into the body's cells in order for them to function properly. For this process to work, your body uses the hormones insulin and glucagon. Insulin helps to transfer the glucose and glucagon stimulates cells in the liver to release the glucose.

When blood sugar (glucose) levels are high in the blood, cells within the pancreas make more insulin in order to increase the transfer of glucose from blood to cells - lowering levels in your blood).

When blood sugar levels are high, the pancreas will make more glucagons and less insulin - resulting in the release of more glucose to the blood.

When you eat a meal, this raises your blood sugar levels and your pancreas will produce insulin to balance the system.



When the pancreas goes wrong

If your pancreas is unable to function properly, it can lead to serious complications. Potential disorders include:



Diabetes

People with type 1 diabetes lack insulin because the insulin-producing cells, the islets, have been destroyed by their own immune system. It is usually possible to control the condition with insulin injections. A lack of insulin causes symptoms of tiredness and frequent urinating, as well as long-term complications, such as kidney disease and eye disease.

Type 2 diabetes is more common among overweight adults and causes the pancreas to lose ability to appropriately produce and release insulin. The body also becomes resistant to insulin, and blood sugar rises.



Pancreatitis

A number of causes can be responsible for pancreatitis - where the pancreas becomes inflamed. The typical causes are gallstones and alcohol, resulting in ruptured ducts and the leaking of digestive juices. This can lead to acute pancreatitis - causing severe tummy pain that arrives suddenly - or chronic pancreatitis - where the situation has been present for many years.

Pancreatitis often requires treatment in hospital.



Cancer of the pancreas

Pancreatic cancer is when a tumour develops in the pancreas. It rarely causes any symptoms when it first develops, which can make it hard to diagnose. There are several types of cancer that arise in the pancreas and different treatments are required.

There are a number of reasons why organ transplant is not an option in cancer treatment. Cancer cells are highly likely to be elsewhere in your body and would continue to grow after a transplant. In addition, transplant patients have to take drugs to suppress their immune systems and stop them rejecting the transplanted organ. Suppressing your immune system is not a good idea if you have a cancer, as the immune system may be helping you fight it.

Pancreas transplants

A pancreas transplant is a complicated operation and is less common than kidney or liver transplantation. Each year around 200 pancreas transplants are performed in the UK and the waiting time for a suitable donated organ is between one and two years.



A pancreas transplant can be carried out in three ways:

  • Simultaneous pancreas–kidney transplant (SPK) - both the pancreas and kidneys are transplanted. This is the most common type, accounting for nine out of 10 transplants. It is used in people who have kidney disease as a result of type 1 diabetes.
  • Pancreas-after-kidney transplant - a person first receives a kidney transplant from a living donor. This is then followed by a pancreas transplant from a recently deceased donor.
  • Pancreas-alone transplant - only the pancreas is transplanted. This is a treatment for patients with very poorly controlled type 1 diabetes who have hypoglycaemic attacks without warning, and which may threaten their life.

A pancreas transplant operation can take four to six hours to complete. However, if you also need a kidney transplant at the same time, the procedure will take a further two hours.

During the transplant procedure your pancreas will not be removed because it will continue to produce digestive juices while the donor pancreas begins to produce insulin.



History and progress of pancreas transplantation

The first pancreas transplantation was performed at the University of Minnesota in 1966, three years after the first kidney transplantation. A pancreas along with kidney and duodenum was transplanted into a 28-year-old woman and her blood sugar levels decreased immediately after transplantation, but three months later she died from pulmonary embolism.

Following this, during the mid 70s and early 80s, due to problems with rejection and infections only partial pancreatic grafts were performed. Numerous methods for dealing with the secretion of pancreatic digestive juices were attempted, none of which proved satisfactory.

Breakthrough developments only occurred following the discovery of ciclosporin (an immunosuppressant drug used to reduce the likelihood of rejection) and crucial international meetings to discuss the successes and failures of pancreas transplantation. Development of whole pancreas transplantation followed during the 1980s with newer surgical techniques. According to the International Pancreas Transplant Registry, nearly 10,000 pancreatic transplantations were recorded by 1998. There are now many more immunosuppressive agents, such as mycophenolate and tacrolimus.

Today, the outlook for people with a pancreas transplant, especially a simultaneous pancreas-kidney transplant, is relatively good. On average a transplanted pancreas functions properly for 10 years.



Islet transplantation

A relatively new technique, known as islet transplantation, is now being used to treat type 1 diabetes. Type 1 diabetes is caused by the destruction of insulin-producing cells in the islets of your pancreas. Instead of transplanting an entire pancreas, these special cells can be extracted from the pancreas of a deceased donor and transplanted into the liver by direct injection through the skin.

This minor procedure is usually done twice for each transplant patient, and can be performed with minimal risk using a needle under local anaesthetic.

This procedure is usually reserved for patients with life-threatening hypoglycaemic attacks. Having an islet transplant can mean improved awareness of hypoglycaemia, less variability in blood glucose levels, improved average blood glucose and better quality of life.

Long-term results are good and are improving all the time. However, the procedure should not be seen as a cure for diabetes. Most people who receive an islet transplant continue to take low-dose insulin therapy and also need to take medication to prevent rejection of the islets.

The UK is fortunate to have the first government-funded islet transplant programme in the world.

Mini Glossary

  • Acinar cells:
    The cells in the pancreas that make digestive enzymes
  • Ciclosporin :
    An immunosuppressant drug widely used in organ transplantation to prevent rejection
  • Diabetes type 1:
    A disorder in which the immune system attacks the insulin-secreting cells in the pancreas. This causes the patient's blood sugar levels to rise to a dangerous level
  • Duodenum:
    The first part of the intestines (gut) connected to the stomach
  • Hypoglycaemia:
    An abnormally low level of sugar (glucose) in the blood
  • Islets of Langerhans:
    The islets are the part of the pancreas responsible for producing hormones

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