Pancreas Transplantation
The entire pancreas or only the cells that produce insulin (islet cells) may be transplanted. Islet cell transplants may consist of the person's own cells (a procedure called islet cell autotransplantation) or cells from another person (a procedure called islet cell allotransplantation). A person's own islet cells can sometimes be used to prevent diabetes from developing when the pancreas must be removed--for example, in people who have chronic pancreatitis causing pain that is difficult to control. Transplantation of another person's islet cells or sometimes the entire pancreas is used to treat people who have diabetes that is difficult to control and has not yet caused serious complications. However, this procedure may have other uses in the future.
Transplantation of an entire pancreas is a major operation, requiring an incision into the abdomen and a general anesthetic. The recipient's pancreas is not removed. Typically, the operation takes about 3 hours and the hospital stay is about 1 to 3 weeks.
In contrast, transplantation of islet cells is not a major operation and requires only a local anesthetic and no hospital stay or only a brief one. Islet cells may be injected through a thin needle into the recipient's umbilical vein in the abdomen or through a tube inserted into a vein to the liver.
More than 80% of people with diabetes who receive a pancreas transplant and about 75% of those who receive an islet cell transplant have normal blood sugar levels afterward and do not need to use insulin. However, people who receive a pancreas or islet cell transplant from another person must take immunosuppressants--a major disadvantage because these drugs increase the risk of infection and have other side effects. Thus, the risk of taking insulin (which can cause abnormally low blood sugar levels) and having less control of diabetes is traded for the risk of taking immunosuppressants (which increases the risk of infection) and having better control of diabetes. Because of the risk of taking immunosuppressants, these transplantations have usually been reserved for people who are already taking immunosuppressants for another reason--for example, those who have received a kidney transplant because of kidney failure. The pancreas and kidney are often transplanted at the same time.
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