Kriti (name changed), a 14-year-old girl from Jaipur, did not know the innocent childhood pleasures of eating ice cream, chocolates, or even fruits for several years due to type 1 diabetes and other health issues that necessitated a restrictive diet.
She was in and out of hospitals for over a year after suffering kidney failure and a diabetic coma, robbing her of her normal life. After reviewing her case, doctors decided to perform a combined kidney and pancreas transplant at the same time.
A day after the procedure, Kriti was able to enjoy a large scoop of chocolate ice cream after her transplant – a rare pleasure she had been denied all her life. The transplant gave her a new lease of life. Six months have passed since her transplant, and she is no longer on insulin or a strict diet. Kriti's parents are grateful for the surgery, which has improved their daughter's life in every way.
We spoke to Dr Swaminathan Sambandam, Senior Consultant & Lead, Multi-Organ Transplant (Liver, Kidney, Pancreas & Small Intestine), Kauvery Hospitals to discuss about pancreas transplants and how they are helping patients with type 1 diabetes transform their lives.
A: The pancreas is a flat pear-shaped glandular organ located just behind the stomach in the abdominal cavity. The pancreas, a digestive organ, is essential for food digestion and the maintenance of glucose levels in the body by secreting insulin and glucagon.
A: Pancreas Transplant, a surgical procedure is a highly specialised treatment that is done to place a healthy pancreas from a deceased donor into a person whose pancreas no longer function properly. Your own pancreas remains in your body after a pancreas transplant. The new pancreas is usually connected to your intestines so that its digestive juices can drain. You will no longer require insulin after a successful transplant. Instead, the new pancreas will produce insulin on your behalf.
A: Pancreas transplant is not a new procedure. It has been around in the western world since several decades. It began in the 1980s and has since evolved into a clinically acceptable procedure. In a typical year, a center performs 20-30 transplants . It is a highly specialised treatment, and there is a lack of awareness about its existence, so it is relatively new and upcoming in India.
A: Patients suffering from type 1 diabetes mellitus with end stage renal disease, selected type 2 diabetes mellitus, failure of insulin therapy for diabetes management, diabetes related organ damage, diabetes related metabolic complications like ketoacidosis, and hypoglycaemic unawareness require pancreas transplant.
A: A pancreas transplant has the advantage of restoring the body's ability to produce and use insulin. This means that the patient will no longer need to test their blood sugar levels daily or take insulin injections to keep their blood sugar levels stable. The serious complications of type 1 diabetes, such as nerve damage, blindness, and stroke, can be avoided with a functioning pancreas. Complications that are already present will not worsen, and some may even reverse.
A: Candidates for transplant are judiciously selected because it is a surgical procedure at the end of the day. It is a metabolic surgery and not just lifestyle modification procedure. A patient is thoroughly assessed based on their medical history. The transplant is done to improve the longevity by preventing damages that will be done by the diabetes itself. A transplant will only be considered when diabetes has started affecting the organs in the body.
A: In majority of cases, pancreas transplant is done using a cadaver donor. In some cases, a segment of the pancreas from a live donor can be used. Live donor transplants has been done in Korea and Japan. However, there are enough organ donors in India. Most of the pancreas is currently being wasted. There is no one to take them. Every year, we donate between 150 and 200 organs in Tamilnadu alone, with only few pancreas transplants.
A: There are three ways pancreas transplants are done:
Pancreas transplant alone: People with diabetes and early or no kidney disease may be candidates for a pancreas transplant alone.
Simultaneous kidney-pancreas transplant: Simultaneous kidney-pancreas transplants for people with diabetes who have kidney failure.
Pancreas-after-kidney transplant: Some patients come after a kidney transplant because they were unaware about pancreas transplant. The transplant is done to ensure the new kidney is not affected due to type 1 Diabetes.
A: The evaluation can be performed as an outpatient or inpatient procedure. During the evaluation, you will meet with a variety of specialists in addition to members of the pancreas transplant team. The pre-transplant tests, in addition to providing a clear picture of your overall health status, aid in the identification of potential problems before they occur. This increases the chances of success.
A: Blood test and chest X-Ray, Ultrasound with Doppler of abdomen, CT Scan/MRI Scan, Pulmonary function test, Echocardiogram.
A: The most common misconception about pancreas transplants is that they are unsuccessful. This, however, is not the case. Pancreas transplants have excellent outcome. The success rate is higher than that of any other cancer surgery. More than 85% of patients live for several years without complications. Underlying conditions such as coronary artery or heart problems that have developed due to long standing diabetes prior to the pancreatic transplant will decide the long term outcome. Furthermore, many people believe that the transplant is a technically difficult procedure. However, it is as simple as a kidney transplant.
A: Patients are listed on the Tamil Nadu state transplant data registry , which is managed by the Transplant Authority of Tamil Nadu organ (TRANSTAN ), a government organisation. Pancreas is distributed in rotation to all centres in Tamil Nadu. Patients are organised according to their blood type.
A: While on the waiting list, the patient should notify the transplant coordinators if they are leaving town or if their health status changes. Until a transplant is scheduled, a transplant team will check in on the patient once a month. Because the patient could be summoned at any time for a transplant, it is critical that they live close to the hospital. In addition, the patient must be able to arrive at the transplant centre within 6 hours of being called in for a transplant.
A: Following pancreas transplantation, the patient will be required to stay in the hospital for two to three weeks, followed by another two to three weeks near the hospital so that they can be monitored on a regular basis.
A: Pancreas transplant is not that very expensive. When a patient is getting simultaneous kidney pancreas transplant the total cost will be about rupees ten to eleven lakhs for the simultaneous transplant. A kidney transplant alone costs around rupees eight lakhs. While doing a simultaneous kidney and pancreas transplant it would cost extra two to three lakhs because the Intensive Care Unit (ICU), hospitalization charges etc would be same like a kidney transplant.
This article was published in association with Kauvery Hospital, and not by TNM Editorial.