Insulin is a hormone that helps the body use glucose for energy. If the beta cells do not produce enough insulin, diabetes will develop. Type I diabetes is an auto-immune process causing the body’s immune system to destroy the beta cells. With whole organ pancreas transplant, it is necessary to transplant both the exocrine and endocrine function and it is necessary to provide a method of drainage of the amylase (which is not needed) and provide the insulin (which is needed). There are two options for drainage of the amylase – bladder drainage or enteric (bowel) drainage.

Bladder drainage – the head of the transplanted pancreas is attached to the bladder to allow the pancreatic duct to drain the amylase and enzymes produced into the bladder where it is emptied out with the urine. The bladder drainage provides a unique method of rejection monitoring by measuring the amount of amylase in the urine. The higher the amylase production, the less concern there is for rejection.
The disadvantages of bladder drainage include irritation of the bladder, urethra, and/or head of the pancreas (pancreatitis) leading to bleeding and urinary tract infections. The excess loss of fluid through the pancreatic duct also leads to dehydration particularly in the first few months after transplant.

Enteric (bowel drainage) – the head of the transplanted pancreas is attached to the bowel to allow the pancreatic duct to drain the amylase and enzymes into the bowel. The advantages of enteric drainage include a decrease in urinary tract infections, pancreatitis, and dehydration. The disadvantages of enteric drainage include a bowel leak where the pancreas is connected to the bowel, an abdominal abscess, and the inability to monitor the amylase reading to determine rejection.

The decision regarding the type of pancreas drainage will be made by the transplant team at the time of the transplant and will depend on many factors including type of transplant (pancreas alone verses simultaneous kidney/pancreas), quality of the donor, number of previous transplants, rejection concerns, etc.

Why is pancreas transplant necessary?
Diabetes mellitus is the leading cause of end-stage-renal disease (ESRD) accounting for 33 percent of newly diagnosed patients with renal failure every year. Individuals with Type I Diabetes Mellitus have insufficient insulin production leading to elevated blood sugars, which must be controlled, with insulin injections and diet. Normally, insulin is produced in the pancreas by islet cells. Healthy islet cells respond to the body’s glucose level, producing the right amount of insulin and preventing complications caused by blood sugar imbalance. Because of the blood sugar imbalance, diabetics experience many long-term complications to their disease, which can include nephropathy (kidney failure), retinopathy (possible blindness), neuropathy (impairment to the nerves of the hands and feet), gastroparesis (“diabetic” stomach or bowel), and cardiovascular disease (heart attacks, strokes, amputations).

Pancreas transplantation has become an acceptable treatment option in carefully selected Type I diabetic patients. A pancreas transplant involves transplanting a donor pancreas into the recipient’s abdomen.

Steroid-Free Protocol
The Nebraska Medical Center Kidney and Pancreas Transplant Program instituted Steroid-Free Protocol in 2001, which eliminates the use of steroids during the transplantation process. Most patients are candidates for this process. Steroids are responsible for many long-term side effects including: weight gain, moon face, acne, osteoporosis, deterioration of the joints, elevated blood sugars, development of diabetes, cataracts, gastric ulcers, and increased cardiac risk, among others. Eliminating steroid use by using newer, equally effective immunosuppression agents can provide tremendous benefits to the patient without the increased risk of rejection.

Steroids (corticosteroids, prednisone, deltasone, medrol) have been used in organ transplantation for many years and have served as a critical agent to prevent rejection, making transplantation possible. New immunosuppression (anti-rejection) agents have lowered the risk of rejection and furthered the success of transplantation. With the lowered risk of rejection, emphasis has been placed on improving the long-term wellness in transplant recipients.