For some people with type 1 diabetes, even frequent insulin injections or use of an insulin pump can no longer prevent serious, life-threatening glucose highs (hyperglycemia) and lows (hypoglycemia). Since there is currently no way to get the beta cells in the pancreas to work again, researchers hypothesized that getting a new pancreas would solve the problem. Years ago, that was only a dream. But thanks to advances in transplantation surgery, it's now a possibility, although a complicated one.

Pancreas transplantation

First, you need to be fairly young (the best candidates are age 45 or younger) and in relatively good health. Second, you need a donor. Since each person has only one pancreas, a living person cannot donate a whole pancreas. But if a close relative is a good match for you, based on your human leukocyte antigen (HLA) type, he or she could provide a partial pancreas transplant. That's often done if a relative is also donating one of his or her kidneys to you, since many people with type 1 diabetes also have severe "end-stage" kidney disease that requires a kidney transplant. But if a living donor is not available, you'll have to wait for a nonliving (cadaver) donor whose pancreas is a good match for you.

Donor organs of all types are scarce and pancreas transplant surgery is technically difficult. However, more than 1,000 pancreas transplants a year are performed in the United States, and yours may be one of them. If so, be sure to choose an experienced surgical team that has performed a large number of pancreas and kidney transplants and has a high rate of successful outcomes. However, even if your pancreas transplant surgery is a success, you'll be trading your daily insulin injections for a lifelong regimen of powerful immune-suppressing drugs to help prevent your body from rejecting the new pancreas.

These drugs can cause serious side effects, including an increased risk of infections and cancer, elevated blood pressure and cholesterol levels, and more rapid deterioration of kidney function. Even with the immunosuppressant treatment, as many as half of all pancreas transplants are rejected.

People who get a combined pancreas-kidney transplant have better survival rates than those who undergo a pancreas transplant alone. If you qualify for a pancreas transplant, it is best to undergo the combined procedure rather than having two separate transplant surgeries. Another advantage is that the same immunosuppressant drugs work for both kidney and pancreas transplants.

There is no evidence that a pancreas transplant (or a combined pancreas-kidney transplant) can halt or reverse any diabetes complications you already have, such as kidney damage (nephropathy), eye damage (retinopathy), or blood vessel damage (macrovascular disease). Indeed, about 5% of people who undergo pancreas or pancreas- kidney transplantation will die within a year, either because of complications of immunosuppressant treatment or of diabetes.

A recent study showed that people still waiting for a pancreas transplant had a lower risk of dying within one to four years than people who had received a transplant. As all of these findings indicate, transplantation is not a perfect solution.

Publication Review By: Written by: Christopher D. Saudek, M.D.; Simeon Margolis, M.D., Ph.D.

Published: 23 Apr 2009

Last Modified: 31 Jul 2014