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Clinical Updates
UCLA Pancreas Transplant Program offers select patients freedom from insulin therapy
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Pancreas transplantation, usually performed simultaneous to kidney transplantation or following a separate kidney-transplant procedure, offers select patients with type 1 diabetes mellitus freedom from insulin therapy. Pancreas transplantation is the only treatment that offers a cure for diabetes.
Diabetes is the leading cause of end-stage renal disease, meaning many diabetic patients seek kidney transplantation as an alternative to lifelong dialysis. These patients are often candidates for pancreas transplantation as well, adding the benefit of restored glucose control at a time when they will already require immunosuppression therapy for their kidney transplant. Pancreas-transplant patients can enjoy freedom from dietary restrictions, blood glucose monitoring and insulin injections.
Three pancreas-transplant options
Most pancreas-transplant patients receive a kidney and pancreas together in a single procedure. UCLA also encourages patients to consider the option of a pancreas-after-kidney procedure. These patients first undergo a living-relateddonor or deceased-donor kidney transplant to treat their chronic renal failure. When a suitable deceased-donor pancreas becomes available, they undergo a second transplant procedure. These patients are free from the need for dialysis as they await their pancreas transplant. And because they are waiting only for a suitable pancreas rather than a pancreas plus kidney, their wait time can be significantly shorter.
A small group of patients make up the third type of pancreas transplant — pancreas transplant alone. Patients suffering low quality-of-life due to hypoglycemic unawareness or brittle diabetic control may be candidates for pancreas transplantation even when not suffering from end-stage renal disease. Hypoglycemic unawareness results in episodes of low blood glucose not accompanied by the symptoms (such as tremor and sweating) that usually alert patients to the condition. Brittle diabetic control refers to quick swings from low blood glucose levels to high, or vice versa. Patients may be candidates for pancreas transplant alone when the risk of diabetic complications outweighs the risks of surgery and immunosuppression.
Pancreas transplantation at UCLA
The program is a collaboration of highly experienced surgical and medical specialists who care for patients throughout the course of their treatment. The team includes specialists in pancreas transplantation, nephrology and urology, as well as psychiatrists, social workers, dietitians and specially trained nurses. Additional consultation from experts in all medical specialties is available at UCLA for patients with complex medical conditions.
In pancreas transplantation, organ selection is critical to achieving good results, and the team at UCLA uses its experience in this area to help it achieve outcomes that are consistently better than the national averages, with very low rejection rates and relatively short average hospital stays.
UCLA pancreas-transplant patients receive outstanding personalized care, with the program’s surgical director meeting with patients before their transplant and continuing to monitor their condition and their care long after the procedure.
Referral
Patients should have their type 1 diabetes diagnosis confirmed by C-peptide testing prior to referral. Patients should be referred as soon as renal insufficiency has been established (creatinine clearance below 20). Early evaluation can lead to treatment earlier in the course of the disease and the progression of diabetic complications. In some cases, patients have been transplanted even before dialysis becomes necessary.
A procedure with life-changing potential
“Patients who undergo pancreas transplantation can return to enjoying normal activities. The emotional, psychological and physiological burden of dialysis and diabetes can be removed from their lives,” says Gerald Lipshutz, M.D., M.S., surgical director of the UCLA Pancreas Transplant Program.
When it is done as part of a simultaneous kidney and pancreas transplant or following a successful separate kidney transplantation — and the vast majority of pancreas transplants fall into these two categories — pancreas transplantation offers a cure for diabetes with no additional immunosuppression risks.
“A successful kidney and pancreas transplant transforms a patient’s life. They’re no longer on dialysis and they’re no longer diabetic. These patients are free from constantly monitoring their blood glucose, injecting insulin or restricting their diets,” stresses Dr. Lipshutz.
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