Background

It is a medical procedure for type 1 diabetes to eliminate the need for insulin injections. 

Pancreatic transplants are common in type 1 diabetes patients who also need kidney transplantation due to kidney failure. 

Pancreas transplant surgery replaces non-functioning pancreas with healthy one from deceased donor. 

The first successful pancreas transplant was performed by Drs. Richard Lillehei and William Kelly in 1966. 

When performing pancreas transplants, consider if venous drainage should go into systemic circulation or portal vein. 

Types of Pancreas Transplantation 

Simultaneous Pancreas-Kidney 

Pancreas-After-Kidney Transplant 

Pancreas Transplant Alone 

Indications

Primary Indications as follows: 

Type 1 Diabetes Mellitus: 

Severe Hypoglycemia Unawareness 

Frequent Episodes of Diabetic Ketoacidosis 

Severe Diabetic Complications 

Type 2 Diabetes Mellitus 

Contraindications

Absolute Contraindications as follows:  

Active Infection 

Malignancy 

Severe Cardiovascular Disease 

Uncontrolled Psychiatric Disorders 

Active Substance Abuse 

Severe Obesity 

Relative Contraindications as follows:  

Age 

History of non-adherence 

Moderate Cardiovascular Disease 

Severe Peripheral Vascular Disease 

Chronic Pulmonary Disease 

Liver Disease 

Outcomes

n graft survival the outcome as follows:  

One-Year Graft Survival 

Five-Year Graft Survival 

Long-Term Graft Survival 

Pancreas transplant restores insulin production, normalizes blood glucose levels and eliminates the need for exogenous insulin. 

Patients experience better quality of life with no insulin injections, improved blood glucose control, and fewer diabetes-related issues. 

Equipment required

Surgical Equipment 

Anesthesia Equipment 

Surgical Drapes and Sterile Supplies 

Surgical Microscopes 

Perfusion Pump 

Monitoring Equipment 

Patient Preparation

Informed Consent:  

Educate patients and their family on procedure, risks, benefits, and post-transplant regimen importance. 

Patient Positioning

The patient is positioned in a supine position and general anesthesia is administered. 

 Fig. Anatomy of Pancreas 

Technique

Step 1: Incision and Exposure 

Surgeons give a midline abdominal incision from xiphoid process to pubic symphysis accesses abdominal cavity. 

Abdominal cavities are examined to locate blood vessels before organ implantation. 

Step 2: Donor Pancreas Preparation 

Donor pancreas is carefully prepared with duodenum and spleen, then preserved in cold solution to minimize injury. 

Step 3: Vascular Anastomosis: 

Prepare iliac vessels or superior mesenteric artery and portal vein for anastomosis.  

Connect donor’s superior mesenteric artery and splenic artery to recipient’s iliac artery with end-to-side anastomosis. 

Step 4: Exocrine Drainage: 

Donor duodenum connected to recipient’s small intestine in end-to-side anastomosis, it is common method which allows pancreatic enzymes to drain in intestine. 

Step 5: Reperfusion and Closure 

Clamps are removed to restore blood flow in pancreas, monitor for bleeding and ensure perfusion. 

Abdominal incision closed in layers with sutures. 

 Fig. Pancreas transplantation 

Complications

Surgical Complications as follows: 

Pancreatic Fistula 

Bleeding 

Thrombosis 

Stenosis 

Vascular Complications as follows:  

Hemorrhage 

Late Complications as follows: 

Cardiovascular Disease 

Renal Dysfunction 

Malignancies 

Chronic Rejection  

References

Pancreas Transplantation – StatPearls – NCBI Bookshelf (nih.gov) 

References

Pancreas Transplantation – StatPearls – NCBI Bookshelf (nih.gov)