Pancreas transplantation
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A '''pancreas transplant''' is an [[organ transplant]] that involves implanting a healthy [[pancreas]] (one that can produce insulin) into a person who has [[diabetes]]. Because the pancreas performs functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas attached in a different location. In the event of rejection of the new pancreas, the recipient could not survive without the native pancreas still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. <ref>[http://www.faqs.org/faqs/diabetes/faq/part3/section-14.html Type 1 cures - pancreas transplants<!-- Bot generated title -->]</ref> Whole pancreas transplants from living donors are not possible, again because the pancreas is a necessary organ for digestion. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes who have severe complications.
==Types==
There are three main types of pancreas transplantation:
* Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor.
* Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant.
* Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent [[hypoglycemia]], but adequate kidney function.
==Indications==
In most cases, pancreas transplantation is performed on individuals with type 1 [[diabetes]] with end-stage [[renal disease]] The majority of pancreas transplantations (>90%) are simultaneous pancreas-kidney transplantions.<ref>{{cite journal | author=Gruessner AC, Sutherland DE | title=Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004 | journal=Clin Transplant | year=2005 | pages=433–55 | volume=19 | issue=4 | pmid=16008587 | doi=10.1111/j.1399-0012.2005.00378.x}}</ref>
==Preservation until implantation==
The donor's blood in the pancreatic tissue will be replaced by an ice-cold organ storage solution, such as UW ([[Viaspan]]) or [[Histidine-tryptophan-ketoglutarate|HTK]] until the allograft pancreatic tissue is implanted.
==Complications==
Complications immediately after surgery include [[transplant rejection|rejection]], [[thrombosis]], [[pancreatitis]] and [[infection]].
==Prognosis==
The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong [[immunosuppression]]. Immunosuppression increases the risk for a number of different kinds of infection<ref>{{cite journal | author=Fishman JA, Rubin RH | title=Infection in organ-transplant recipients | journal=N Engl J Med | year=1998 | pages=1741–51 | volume=338 | issue=24 | pmid=9624195 | doi=10.1056/NEJM199806113382407}} ''[http://content.nejm.org/cgi/content/full/338/24/1741 Full text]''</ref> and cancer.
==History==
The first pancreas transplantation was performed in 1966, three years after the first kidney transplantation.<ref>{{cite journal | author=Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC | title=Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy | journal=Surgery | year=1967 | pages=827–37 | volume=61 | issue=6 | pmid=5338113}}</ref> 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 eventually she died three months later from pulmonary embolism. In 1979 the first living-related partial pancreas transplantation was done.
==References==
{{reflist}}
* {{cite journal | author=Larsen JL | title=Pancreas transplantation: indications and consequences | journal=Endocr Rev | year=2004 | pages=919–46 | volume=25 | issue=6 | pmid=15583023 | doi=10.1210/er.2002-0036}} ''[http://edrv.endojournals.org/cgi/content/full/25/6/919 Full text]''
* [http://www.ipita.org/ International Pancreas transplantation Association]
==External links==
* [http://www.diabetesinstitute.org/ Diabetes Institute for Immunology and Transplantation]
* [http://www.ipita.org/ International Pancreas transplantation Association]
{{Organ transplantation}}
{{Digestive system surgical procedures}}
[[Category:Surgery]]
[[Category:Transplantation medicine]]
[[pt:Transplante de pâncreas]]