Pancreas Transplantation

01 Overview

Pancreas transplantation restores endogenous insulin production and is most often performed alongside kidney transplantation in patients with type 1 diabetes and diabetic nephropathy.

02 Anatomy

The donor pancreas, usually with a segment of duodenum, is implanted with vascular anastomoses to the iliac vessels, and exocrine drainage is achieved via enteric or, less commonly, bladder drainage of the duodenal segment.

03 Physiology

The transplanted pancreas restores physiological, glucose-responsive insulin secretion, which can normalise glycaemic control and reduce the risk of progression of diabetic complications more effectively than exogenous insulin therapy.

04 Indications

Indications include:

• Type 1 diabetes with diabetic nephropathy (often combined kidney-pancreas)
• Type 1 diabetes with severe glycaemic instability or hypoglycaemia unawareness
• Selected cases after a prior kidney transplant

05 Contraindications

Contraindications include:

• Significant uncorrected cardiovascular disease
• Active infection or malignancy
• Severe obesity or frailty increasing operative risk
• Inability to tolerate immunosuppression

06 Donor Assessment

Donors are evaluated for pancreatic anatomy and absence of significant pancreatic disease, with careful attention to donor age and body habitus given the organ's vascular fragility.

07 Recipient Assessment

Candidates are assessed for cardiovascular risk, which is often elevated in long-standing diabetes, along with renal function, infection risk, and suitability for combined or pancreas-alone transplantation.

08 Surgical Technique (Summary)

The pancreas graft is implanted intraperitoneally, with arterial inflow via a reconstructed donor iliac Y-graft and venous drainage to the iliac or portal system, alongside duodenal segment drainage.

09 Immunosuppression (Overview)

Regimens resemble those used for other abdominal organ transplants, combining induction with maintenance calcineurin inhibitor, antiproliferative agent, and corticosteroids, with close monitoring given the pancreas's sensitivity to rejection.

10 Complications

Recognised complications include:

• Graft thrombosis
• Pancreatitis of the graft
• Anastomotic leak
• Rejection
• Infection

11 Follow-up

Follow-up tracks glycaemic control and graft enzyme levels, with imaging where indicated, alongside standard post-transplant surveillance for infection, rejection, and cardiovascular risk.