PANCREAS TRANSPLANTATION

General Information

DEFINITION--Replacement of a diseased pancreas with a healthy pancreas obtained immediately after death from a donor with compatible immunological characteristics. The duodenum is also replaced to allow drainage of pancreatic secretions into the gastrointestinal tract.

BODY PARTS INVOLVED--Diseased or abnormal pancreas and duodenum; healthy donor pancreas and duodenum.

REASONS FOR SURGERY--Prevention of complications of severe diabetes mellitus, such as kidney failure and damage to the retinas.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity; smoking; stress.
• Poor nutrition.
• Excess alcohol consumption.
• Recent or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs.

What To Expect

WHO OPERATES--General surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Evaluation of all body systems; immune-system and pancreas matching procedures.
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• The pancreas is removed from the donor, chilled and preserved up to 12 hours until surgery.
• An incision is made under the ribs.
• The abdominal muscles are divided and the peritoneal cavity is entered.
• The pancreas and duodenum are cut free and removed.
• The donor pancreas and duodenum are positioned and connected to blood vessels.
• Sometimes, only the cells of the pancreas that produce insulin (islet cells) are transplanted. In some patients, this is all that is necessary to re-establish normal function.
• The peritoneum and muscles are closed. The skin is closed with sutures or clips, which usually can be removed in 1 week.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Rejection of transplant.
• Development of a pancreatic fistula.

AVERAGE HOSPITAL STAY--3 weeks.

PROBABLE OUTCOME--Islet-cell transplants are usually successful in giving young diabetics near-normal life expectancy. In adults, a successful transplant prolongs life and improves the quality of life for patients who might otherwise have died, but life expectancy is currently unknown. Allow about 6 months for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the chance of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Stool softeners to prevent constipation. > Antibiotics to fight infection. > Immunosuppressants to decrease the likelihood of rejection.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 months.

DIET---You doctor will prescribe a diet.

Call Your Doctor If

Any of the following occur:

• Increased pain, swelling, redness, drainage or bleeding in the surgical area.
• Headache, muscle aches, dizziness or a general ill feeling and fever.
• Nausea, vomiting, constipation or abdominal swelling.
• Increased frequency of urination or increased thirst.
• New, unexplained symptoms. Drugs used in treatment may produce side effects.