Pancreas transplantation (PG) was first performed in 1891. A patient with severe diabetes mellitus in a coma was injected into the abdominal wall with a suspension of cells from the donor's pancreas. 30 years later, insulin was discovered.

In 1966, the first transplant was performed: an attempt was made to insert a small part of the donor pancreas into the iliac fossa in a patient with high glycemia. The duct through which pancreatic juice is secreted was tied up. An unfavorable outcome followed: after 2 months the tissue was rejected, sepsis developed, and the patient died. But within two months, while she was alive, her blood sugar normalized, and positive results were achieved in her general condition. This operation and its modifications are still used today.

Is it possible to transplant a pancreas?

Pancreatic transplantation, despite the complexity of the operation, continues to be performed. Approximately 200 cases of transplantation have been performed in the world, and every year, according to statistics, 1 thousand people undergo this operation.

This is due to technical features, the high cost of the operation and the pronounced sensitivity of the gland, which is damaged even when you touch it with a finger. In addition, during the operation, the recipient has a high probability of releasing a large amount of trypsin and self-digestion of the organ. A similar situation can occur in a living donor when part of an organ is removed: leakage of juice with enzymes as a result of surgical damage leads to the development of pathology of other abdominal organs and destruction of the own pancreas.

Indications for prescribing surgery for a patient

The operation was developed to save patients with type 1 diabetes. Initially, the goal was to achieve normoglycemia and relieve the patient from hourly insulin administration. For this purpose, non-functioning or damaged β-cells of the islets of Langerhans must be replaced with healthy ones. But after this, instead of insulin injections, it becomes necessary to constantly take immunosuppressants to prevent rejection of a foreign organ or part of it.

Indications for transplantation are:

• insulin-dependent diabetes mellitus in patients with incipient renal failure who will require hemodialysis or a kidney transplant in the near future (according to statistics, in 90% of cases of the disease, gland and kidney transplantation is done simultaneously);
• secondary diabetes resulting from deep tissue damage to the pancreas (cancer, pancreatitis, pigmentary cirrhosis);
• developed insulin resistance (Cushing's syndrome, acromegaly);
• unexplained hypoglycemia;
• lack of effect from standard treatment.

If indicated, the operation must be performed before irreversible complications develop in the form of:

• severe retinopathy and blindness;
• severe neuropathy;
• microcirculation lesions with tissue necrosis and diseases of large vascular trunks.

Any intervention on the pancreas is associated with technical difficulties that are incomparable with liver or kidney transplantation. Only very strict indications and the lack of alternatives to drug therapy allow the use of such a radical method.

The need for surgical replacement of an organ with a donor also arises in cases of severe damage to the tissue of the gland, as a result of which all its functions are significantly impaired and cannot be corrected:

• neoplasms (benign);
• in the abdominal cavity, affecting the pancreas;
• mass death of organ cells (chronic pancreatitis with frequent exacerbations, pancreatic necrosis).

Due to technical and organizational difficulties and high financial costs, organ transplantation in the listed cases is extremely rarely prescribed. The main indication remains severe diabetes mellitus.

Contraindications for organ transplantation

Surgery is needed mainly in severely ill patients, when standard treatment for diabetes is ineffective and there are already complications. Therefore, contraindications to surgical intervention are relative:

• age - over 55 years;
• the presence of malignant neoplasms in the body;
• history of myocardial infarction or stroke;
• pathology of blood vessels and heart caused by pronounced atherosclerotic changes (complicated forms of coronary artery disease, deep damage to the aorta and iliac vessels by atherosclerosis, operations on the coronary arteries in the past);
• cardiomyopathy with low ejection fraction;
• complications of diabetes mellitus in a severe stage;
• active tuberculosis;
• drug addiction, alcoholism, AIDS.

Diagnosis before prescribing a transplant

If, nevertheless, it is impossible to do without surgery, the patient must undergo a thorough examination to exclude unexpected serious complications both during the operation and in the postoperative period.

A number of mandatory functional examinations are established by the operation protocols:

• R0 OGK (chest x-ray);
• Ultrasound of the abdominal cavity and the gastrointestinal tract (abdominal organs and retroperitoneal space);
• CT (computed tomography).

Required laboratory tests include:

• general clinical and, including blood and urine amylase;
• urine tests to study kidney function;
• tests for hepatitis, HIV, RW;
• determination of blood group and Rh factor.

Consultations with narrow specialists are scheduled:

• endocrinologist;
• gastroenterologist;
• cardiologist;
• nephrologist and those to whom surgeons deem it necessary to refer.

In some cases, further examination is required: it is prescribed for severe diabetes complicated by neuropathy. In such a situation, a diabetic may not feel attacks of angina, so he does not complain, and, despite severe atherosclerosis of the coronary vessels and heart failure, the diagnosis of IHD (coronary heart disease) is not made. To clarify it, the following is carried out:

• echocardiography,
• vascular angiography;
• radioisotope study of the heart.

Types of gland transplants

Radical treatment can be carried out in different volumes. During the operation the following is transplanted:

• individual segments of the gland (tail or body);
• pancreaticoduodenal complex (the entire gland with a segment of the duodenum immediately adjacent to it);
• completely the gland and kidneys at the same time (90% of cases);
• pancreas after prior kidney transplantation;
• culture of donor β-cells that produce insulin.

The extent of surgical intervention depends on the extent of damage to organ tissue, the general condition of the patient and examination data. The decision is made by the surgeon.

The operation is planned because it requires serious preparation of the patient and the graft.

Transplant surgery technique

The donor organ is placed in the iliac fossa (the kidney is also placed there) through a midline incision along the linea alba of the abdomen. It receives arterial circulation through its vessels from the recipient’s aorta. Venous outflow occurs through the portal vein system (this is the most physiological route) or the inferior vena cava. The pancreas is connected to the wall of the patient’s small intestine or bladder side to side.

The pancreatic duct, through which pancreatic juice containing digestive enzymes passes, is discharged into the lumen of the small intestine or bladder. In the latter case, this occurs through a cuff formed from a portion of the donor's duodenum (DU) from which the gland was transplanted.

The duration of the operation is at least 4 hours.

If a synchronous (simultaneous) transplantation of the pancreas with a kidney is necessary, then the more physiological first option is preferable - attachment to the small intestine. Thus, the development of severe complications that arise when stitched to the bladder is excluded. The likelihood of pancreas rejection increases many times over if it is implanted together with a kidney. This is due to the fact that, compared to the gland, the kidneys are rejected more often. Rejection of a separately transplanted pancreas is difficult to track.

Extraction of the duct into the bladder (this is done either when transplanting only the pancreas - without a kidney, or when transplanting the gland after an already transplanted kidney) makes it possible:

• monitor the level as a marker of damage and, thus, identify the process of graft rejection in the early period;
• reduce the risk of developing infection.

There are many disadvantages to draining the pancreatic duct into the bladder:

• development of acidosis;
• hematuria;
• the occurrence of infections;
• formation of stricture (narrowing) of the urethra.

If a small part of the pancreas is transplanted, neoprene, an artificial material that quickly hardens, is used to drain pancreatic juice. But this method is rarely used. Typically, the duct is diverted into the bladder or intestines, as in a whole gland transplant.

With a successful transplant, there is no rejection of the donor organ. Glucose levels normalize within the first few days, and there is no need for insulin. In this case, the patient is transferred to long-term use of immunosuppressants. The regimen includes 3 drugs with multidirectional mechanisms of action.

The purpose of the operation, in addition to normalizing carbohydrate metabolism, is to prevent the occurrence and progression of life-threatening complications:

• nephropathy;
• retinopathy (prevention of blindness);
• neuropathy.

When this task is accomplished, the quality of life after transplantation is significantly improved compared with life on hemodialysis.

Transplantation of islets of Langerhans

Theoretically, hyperglycemia can be normalized by transplanting islets of Langerhans or introducing into the body their β-cells, which produce insulin. In practice, this is extremely difficult to do. The following steps are required:

• grind the donor's pancreas;
• add collagenase to the resulting mixture of cells;
• centrifuge the treated cells in a special centrifuge;
• inject the resulting cell mass into the portal vein, spleen or kidney capsule.

After all the preparatory manipulations, an extremely small number of viable cells is obtained from one gland, insufficient for the procedure. The technique is in the process of being refined, and other options for introducing ready-made donor cells are being actively studied. For example, attempts are being made to transplant the pancreas of an embryo, but after transplantation it is capable of growing and secreting insulin for a short time.

Artificial pancreas

Research and development is underway on artificial graft transplantation. If they end successfully, this will solve the problem, since the technique has a number of advantages:

• there is no need to depend on the donor - the transplant can be performed at any time, even urgently;
• An artificial organ completely imitates all the functions of a natural one.

It is a complex device with a sensor that determines the amount of glucose in the blood. The main purpose of artificial pancreas is to meet the body's insulin needs, so the main indication is diabetes mellitus.

The pancreas cannot survive for more than half an hour without oxygen. Therefore, cold preservation is used for storage, which allows the vital functions of the organ to be preserved for 3–6 hours. This complicates the selection of a donor. To avoid such situations, new technologies are used: for example, only the low-functional part of the pancreas - the tail - is transplanted, followed by the introduction of implants into the ducts. Such operations are effective in 85% of cases.

Prognosis after surgery

The most physiological and relatively safe method with the best survival prognosis is simultaneous pancreas and kidney transplantation. The cost of such an operation significantly exceeds all other options; it requires a long time to prepare and perform it and highly qualified surgeon.

Organ transplant surgery and its outcome directly depend on several factors. Important things to consider:

• the volume of graft functions performed at the time of surgery;
• age and general condition of the donor at the time of death;
• compatibility of donor and recipient tissues in all respects;
• hemodynamic stability of the patient.

According to existing statistics, survival after pancreas transplantation from a cadaveric donor is:

• two years – in 83% of cases;
• about five years – in 72%.

Transplantation from living relative donors is also carried out, but the experience is still limited. Although the statistics are more optimistic in the future:

• survival rate within a year - 68%;
• within 10 years - complete recovery of health is observed in 38% of patients.

It is impossible to completely transplant the gland from a living donor, since the organ is unpaired, and a person cannot live without it.

If organ rejection begins after surgery, the prognosis is unfavorable. It is extremely difficult to stop the process in such cases; the patient may die within the next few days or weeks. It should be noted that rejection is extremely rare.

It was observed that the transplanted organ stopped working after a few years - then the patient was again prescribed insulin therapy or the question of re-transplantation was raised.

In which countries are pancreas transplants performed?

Due to the high technical complexity of the operation, it is recommended to perform it in well-known clinics with certain experience and highly qualified specialists. There are large transplant centers in many countries. Well proven:

• Russia;
• Belarus;
• Kazakhstan;
• Germany;
• Israel;
• America.

How much an operation can cost depends on the price of not only the surgical procedure itself, but also other components:

• preparing the patient for surgery;
• rehabilitation period;
• labor of medical personnel involved in the operation and patient care after it.

The cost of a pancreas transplant ranges from $275,500 to $289,500. If the transplant is performed together with a kidney, the price almost doubles and amounts to approximately $439 thousand.

Selection of organs and their distribution among patients

Organs for transplantation are removed from recently deceased patients no older than 55 years. Even a child as young as three years old can be a donor. The donor must not have a history of glucose intolerance or alcoholism, and the cause of death is a cerebral catastrophe (stroke). In addition to these requirements, the donor must be healthy at the time of death and not have:

• pancreatitis;
• infections in the abdominal cavity;
• traumatic injuries;
• atherosclerosis of the abdominal aorta.

Because the pancreas is an extremely sensitive organ, it is removed to preserve its integrity along with the liver and spleen. Then the liver is separated, and the spleen with the gland and part of the duodenum is preserved using special solutions, placing them in a shipping container at a low temperature. Pancreas can be stored for no more than 20 hours. In preparation for transplantation, a number of tissue compatibility tests are performed.

If a simultaneous transplant of the pancreas along with a kidney is necessary, these organs must be from the same donor.

A tiny number of segmental pancreatic transplants are performed from living people - they account for less than 1%. But their use is limited due to the development of serious complications for the donor:

• splenic infarction;
• pancreatitis;
• diabetic abscess;
• leakage of pancreatic juice as a result of removal of part of the pancreas and the formation of a cyst;
• secondary diabetes.

If the graft functions well and there are no complications, the quality of life and its duration are significantly increased. It is important to carefully follow all the doctor’s recommendations during the rehabilitation period - not only good health, but also life depends on this.

Bibliography

1. All-Russian public organization of transplantologists, Russian Transplantology Society. Pancreas transplantation. National clinical guidelines 2013
2. Zainutdinov, A. M. Acute destructive pancreatitis: choosing the optimal treatment method. Annals of Surgery 2008 No. 6 pp. 10–14.
3. Leonovich S.I., Ignatovich I.N., Sluka B.A. Transplantation of pancreatic islet cell culture into red bone marrow in an experiment. Belarusian Medical Journal 2004 No. 1, pp. 55–57.
4. Shumakov V.I., Ignatenko S.N., Petrov G.N. and others. Kidney and pancreas transplantation for patients with insulin-dependent diabetes mellitus. Surgery 1991 No. 7 pp. 3–8.
5. Bozhenkov, Yu. G. Practical pancreatology. Guide for doctors M. Med. book N. Novgorod Publishing House NGMA, 2003
6. Prayer books A.B. Pancreas surgery: acute pancreatitis, pancreas trauma, pancreas transplantation. Russian Medical Journal, 1996, No. 4, 3, pp. 151–153.

Type 1 diabetes mellitus (insulin-dependent) is the most common disease worldwide. According to statistics from the World Health Organization, today about 80 million people suffer from this disease, and there is a definite tendency for this figure to increase.

Despite the fact that doctors manage to fight such diseases quite successfully using classical methods of treatment, there are problems that are associated with the onset of complications of diabetes mellitus, and a pancreas transplant may be required. Speaking in numbers, patients with insulin-dependent diabetes:

1. go blind 25 times more often than others;
2. 17 times more likely to suffer from kidney failure;
3. are affected by gangrene 5 times more often;
4. have heart problems 2 times more often than other people.

In addition, the average life expectancy of diabetics is almost a third shorter than that of those who do not suffer from dependence on blood sugar.

Methods of treating the pancreas

When using replacement therapy, the effect may not be on all patients, and not everyone can afford the cost of such treatment. This can be easily explained by the fact that drugs for treatment and its correct dosage are quite difficult to select, especially since this must be done on an individual basis.

Doctors were encouraged to search for new treatment methods by:

• severity of diabetes;
• the nature of the outcome of the disease;
• difficulties in correcting complications of carbohydrate metabolism.

More modern methods of getting rid of the disease include:

1. hardware methods of treatment;
2. pancreas transplantation;
3. pancreas transplant;
4. islet cell transplantation.

Due to the fact that in diabetes mellitus metabolic changes can be detected that appear due to disruption of the normal functioning of beta cells, treatment of the disease may be due to transplantation of the islets of Langerhans.

Such a surgical intervention can help regulate abnormalities in metabolic processes or become the key to preventing the development of serious secondary complications of insulin-dependent diabetes mellitus, despite the high cost of the operation; in diabetes, such a decision is completely justified.

Islet cells are not able to be responsible for adjusting carbohydrate metabolism in patients for a long time. That is why it is best to resort to allotransplantation of the donor pancreas that has retained its functions as much as possible. Such a process involves providing conditions for normoglycemia and subsequent blocking of metabolic mechanism failures.

In some cases, there is a real opportunity to reverse the development of diabetes complications that have begun or stop them.

Advances in Transplantation

The first pancreas transplant was performed in December 1966. The recipient managed to achieve normoglycemia and independence from insulin, but this does not make it possible to call the operation successful, because the woman died 2 months later as a result of organ rejection and blood poisoning.

Despite this, the results of all subsequent pancreas transplants were more than successful. At the moment, transplantation of this important organ cannot be inferior in effectiveness to transplantation:

1. liver;
2. kidney;
3. hearts.

In recent years, medicine has managed to make great strides in this area. When cyclosporine A (CyA) was used with low-dose steroids, patient and graft survival increased.

Patients with diabetes are exposed to significant risks during organ transplantation. There is a fairly high probability of complications of both an immune and non-immune nature. They can lead to stopping the function of the transplanted organ and even death.

An important note will be the information that with a high mortality rate in patients with diabetes during surgery, the disease does not pose a threat to their lives. If a liver or heart transplant cannot be postponed, then a pancreas transplant is not a surgical intervention for life-saving reasons.

To resolve the dilemma of the need for an organ transplant, it is first necessary to:

• improve the patient's standard of living;
• compare the degree of secondary complications with the risks of surgery;
• assess the patient’s immunological status.

Be that as it may, pancreas transplantation is a matter of personal choice for a sick person who is at the stage of end-stage renal failure. Most of these people will have symptoms of diabetes, such as nephropathy or retinopathy.

Only with a successful outcome of surgical intervention does it become possible to talk about relieving secondary complications of diabetes and manifestations of nephropathy. In this case, it is necessary to perform transplantation simultaneous or sequential. The first option involves the removal of organs from one donor, and the second - transplantation of a kidney, and then a pancreas.

End-stage renal failure usually develops in those who developed insulin-dependent diabetes mellitus 20-30 years ago, and the average age of those operated on is people from 25 to 45 years.

What type of transplant is better to choose?

The question of the optimal method of performing surgical intervention has not yet been resolved in a certain direction, because debates about simultaneous or sequential transplantation have been going on for a long time. According to statistics and medical research, the function of the pancreas graft after surgery is much better if a simultaneous transplant was performed. This is due to the minimal possibility of organ rejection. However, if we consider the percentage of survival, then in this case sequential transplantation will prevail, which is determined by a fairly careful selection of patients.

In order to prevent the development of secondary pathologies of diabetes mellitus, pancreas transplantation must be performed at the earliest possible stages of the development of the disease. Due to the fact that the main indication for transplantation may only be a serious threat of significant secondary complications, it is important to highlight some prognoses. The first of these is proteinuria. When persistent proteinuria occurs, kidney function rapidly deteriorates, but this process can have varying intensity of development.

As a rule, in half of those patients who have been diagnosed with the initial stage of stable proteinuria, after about 7 years, renal failure begins, in particular, the terminal stage. If in a person suffering from diabetes mellitus without proteinuria, death is possible 2 times more often than the background level, then in those suffering from persistent proteinuria this figure increases by 100 percent. By the same principle, nephropathy that is just developing should be considered as a justified pancreas transplant.

At later stages of development of insulin-dependent diabetes mellitus, organ transplantation is extremely undesirable. If significantly reduced kidney function is observed, then it is almost impossible to eliminate the pathological process in the tissues of this organ. For this reason, such patients may no longer survive the nephrotic state that is caused by CyA immunosuppression after organ transplantation.

The lowest possible level of the functional state of a diabetic's kidneys should be considered the one at which the glomerular filtration rate is 60 ml/min. If the indicated indicator is below this mark, then in such cases we can talk about the likelihood of preparation for a combined kidney and pancreas transplant. With a glomerular filtration rate of more than 60 ml/min, the patient has a fairly significant chance of relatively rapid stabilization of kidney function. In this case, it would be optimal to transplant only one pancreas.

Cases requiring transplantation

In recent years, pancreas transplantation has become used for complications of insulin-dependent diabetes. In such cases we are talking about patients:

• those who have hyperlabile diabetes;
• diabetes mellitus with the absence or disturbance of hormonal replacement of hypoglycemia;
• those who are resistant to subcutaneous administration of insulin of varying degrees of absorption.

Even in view of the extreme risk of complications and the serious discomfort that they cause, patients can easily maintain renal functionality and tolerate treatment for SuA.

At the moment, treatment with this method has already been performed on several patients from each specified group. In each situation, significant positive changes in their health were noted. There are also cases of pancreas transplantation after complete pancreatectomy caused by chronic pancreatitis. Exogenous and endocrine functions were restored.

Those who have undergone pancreas transplants due to advanced retinopathy have failed to experience significant improvements in their condition. In some situations, regression was also noted. It is important to add to this issue that organ transplantation was carried out against the background of quite serious changes in the body. There is an opinion that greater effectiveness could be achieved if surgery were performed at earlier stages of diabetes mellitus, because, for example, it is quite easy to diagnose.

They move to the stage of failure of conservative treatment, then surgery cannot be avoided. It solves many healing problems. The most difficult operation is a pancreas transplant.

Such operations began to be carried out in 1966. Today, their quantity and quality have increased, which is reflected in an increase in life expectancy after operations. The gland is transplanted in separate parts or completely. There is always a risk of graft rejection.

Its success is associated with numerous problems. The technical difficulties are incomparable to liver and kidney transplantation. Only very strict indications allow such an operation to be performed.

In order to determine the need for an organ transplant, the patient is prescribed a full examination according to the disease management protocol:

Instrumental diagnostics:

• ultrasound examination of the heart muscle, peritoneal organs, blood vessels,
• chest x-ray;
• electrocardiogram;
• laboratory research:
• biochemistry of blood composition;
• urine, blood clinical tests;
• serological analysis for infections;
• blood type confirmation.

Other studies are also possible, prescribed by professionals of narrow specializations:

• gastroenterologist;
• abdominal surgeon;
• gynecologist;
• therapist;
• anesthesiologist;
• endocrinologist;
• dentist

Most often, a surgical solution to the problem is offered to patients with type 1 or type 2 diabetes mellitus before their consequences begin:

• hyperlabile diabetes;
• neuropathy;
• inferiority of the functions of the endocrine or exocrine parts;
• threat of blindness due to retinopathy - damage to the retina of the eyeball;
• kidney damage - nephropathy;
• severe vascular diseases.

Therefore, a pancreas transplant for diabetes mellitus is not vital. It helps prevent the severe consequences of diabetes.

Symptomatic diabetes mellitus, i.e. secondary, is the cause of the development of the following complications:

• pancreatitis, accompanied by the development of pancreatic necrosis;
• hemochromatosis;
• insulin immunity;
• pancreas cancer;

Pancreas transplantation is indicated for these diseases

Particular attention should be paid to organ transplantation. This is due to the fact that most often malfunctions of the organ are accompanied by the development of such a disease. But its consequences and complications are a direct path to surgical intervention if conservative therapy does not bring results.

When signs of a purulent-destructive nature may appear, this happens within 7-14 days. In addition, the injured pancreas may develop oncology. All complications of pancreatitis that require surgical intervention can lead to a transplant of an organ or its parts.

Rare cases of indications for transplantation for structural damage:

• tumors of various types, leading to diffusion of the gland;
• significant necrosis of the components of the gland;
• damage to the gland that is not amenable to conservative therapy, which occurred as a result of purulent inflammation in the peritoneum.

What kind of transplant is ahead and its distinctive features

The nature of organ tissue destruction, analysis of the patient’s readiness for surgery, which is based on examination, cornerstones in choosing a transplant surgery:

• iron in full;
• its tail;
• organ body zones;
• gland plus a section of the duodenum, the so-called pancreatic - duodenal complex;
• cell therapy with cultures of beta cells of the gland.

Unlike the kidneys, the pancreas is one organ in the body. Pancreas transplantation, its success depends on the selection of a donor and the collection of the pancreas.

The donor's age can be from 3 to 55 years, the main thing is that he is healthy, and his condition is accompanied by brain death. To determine the indications for organ donation, the donor is tested for various infections and diseases.

If the organ is suitable, then it is alienated either with the liver and duodenum, or each separately. In any case, the pancreas is separated from them, preserved in a special solution, and stored in a container at a low temperature for no more than 20–30 hours.

There are various methods for removing enzyme juice during operations:

1. Transplantation in sections or segments uses blocking of the outlet channel with a rubber polymer, neoprene or other synthetic quick-hardening material.
2. Enzyme juice can be diverted to other excretory organs: intestines, bladder. The disadvantage of such associations with the excretory duct is subsequent diseases of the organ, manifested by hematuria, infections, acidosis, and loss of a significant volume of bicarbonate enzymes. But it is possible to recognize the onset of transplant rejection by monitoring the amylase content in the urine.

Diabetic nephropathy involves a kidney and pancreas transplant. Here one of the transfer routes is chosen:

• only iron;
• first the kidney, then the pancreas in succession;
• simultaneous kidney and gland transplantation, which has become preferable to others.

The development of medicine does not stand still. New innovations are replacing standard transplant methods. Among them is transplantation of cells of the islets of Langerhans. So far this is difficult to do. The mechanism of action of this operation:

• grind the donor's pancreas, exposing the cell composition to the influence of collagenase;
• in a special centrifuge they must be divided into fractions according to density;
• the viable material that can be extracted is injected into the organs: spleen, under the kidney capsule, portal vein.

This technique is at the beginning of its life. But if the experiment is successful, types 1 and 2 are able to produce their own insulin, which improves the quality of life of the lucky ones.

Another experimental technique is to attempt a pancreas transplant from a 16–20 week embryo. The embryonic gland weighs 10-20 mg, but can already secrete insulin as it grows. According to unverified statistics, up to 200 such transplants have been performed, but success is limited.

Transplant results

The patient is always concerned about the success of the operation. In many ways, its outcome depends on the preoperative protocol:

• histocompatibility results depending on tests for graft antigens;
• The transplant operation must be planned. An urgent operation does not allow the entire protocol of measures to prepare the patient and the transplant to be completed;
• the transplant should be carried out in specialized organ transplantation clinics that have accumulated experience in such operations;
• sufficient funding for the operation.

After the intervention, long-term observation, tests, and examinations follow, which will allow us to draw a conclusion about the result of the transplantation:

1. If carbohydrate metabolism returns to normal and the patient is freed from the need for insulin, then the transplant was successful. If in addition a kidney is transplanted, it is possible to stop the intensification of diseases leading to kidney hemodialysis: neuropathy, retinopathy, nephropathy:
2. Rejection does not appear immediately. One gland, as a rule, is not rejected; it is accompanied by rejection of the kidney, if there was such a transplant. For the kidney, characteristic signs of rejection include an increase in creatinine, oliguria and other tests, which also serves as an indicator for the gland. The graft swells, its edges are blurred, the tail is poorly visualized when examined by ultrasound or MRI.

In any case, patients are prescribed immunosuppressive therapy for life. Its goal is to suppress unnecessary, aggressive manifestations of immune reactions against the cells of one’s own body. It has a protocol for use consisting of 2-3 drugs that have different mechanisms of action, as well as symptomatic therapy. This is a necessary condition for maintaining the survival rate of the transplanted organ.

Subsequently, the patient is undergoing medical examination and continues to be treated at home, receiving detailed recommendations from the doctor, including a new quality of life.

Pancreas transplantation for diabetes mellitus is rarely prescribed compared to transplantation of other organs. These surgical treatments are associated with a huge risk. Surgical intervention is often used if other methods of influence are not enough. Such surgical interventions involve certain technical and organizational difficulties regarding their implementation.

In medical practice, modern methods of eliminating the disease are distinguished.

1. Hardware treatment methods.
2. gland.
3. Pancreas transplantation.
4. Pancreatic islet transplantation.

Due to the fact that in diabetic pathology it is possible to identify metabolic changes that have developed due to changes in the natural activity of beta cells, therapy for the pathology will be predetermined by the procedure for replacing the islets of Langerhans.

This surgical treatment helps in regulating discrepancies in metabolic phenomena or guarantees the formation of severe recurrent complications of diabetes, which is dependent on glucose, regardless of the high cost of surgical treatment.

In case of diabetes, such a decision is completely justified.

The islet cells of the body are unable to bear responsibility for regulating carbohydrate metabolism in patients for a long period of time. Therefore, allotransplantations are used to replace the islets of Langerhans from a donor gland, which retains its own activity to the maximum. This phenomenon awaits the provision of circumstances for normoglycemia and another blockade of metabolic mechanism disorders.

In some situations, it becomes possible to actually achieve the opposite formation of developed complications of diabetic disease or stop them.

Pancreas transplantation for diabetic pathology is a dangerous procedure, therefore such interventions are carried out only in the most extreme situations.

Pancreatic organ transplantation is often performed for people who suffer from both type 1 diabetic disease and type 2 with already manifested renal failure before the patient begins to experience irreversible complications in the form of:

• retinopathy with complete loss of vision;
• diseases of large and small vessels;
• neuropathy;
• nephropathy;
• endocrine deficiency.

A gland transplant is also carried out in cases of secondary diabetic disease provoked by pancreatic necrosis, which has become a complication of pancreatitis occurring in the acute phase, and a substandard formation of the pancreas, but if the disease is at the stage of formation.

Often a factor in transplantation is hemochromatosis, as well as the victim’s immunity to sugar.

In quite rare situations, gland transplantation for diabetes mellitus is prescribed for patients with a number of pathologies.

1. pancreas.
2. Damage to the gland by a tumor formation of a benign or malignant course.
3. A purulent inflammatory phenomenon in the peritoneum, which leads to the development of severe damage to pancreatic tissue that is not amenable to any therapy.

Often, when renal insufficiency occurs, the patient, along with a pancreas transplant, will also need kidney surgery performed directly on the pancreas.

Contraindications for transplantation

Apart from the indications, a pancreas transplant will not be feasible for various reasons.

1. The presence and formation of neoplasms of poor quality.
2. Heart diseases characterized by severe vascular insufficiency.
3. Complications of diabetes.
4. The presence of lung pathologies, previous stroke, infectious diseases.
5. Dependence on alcohol, drugs.
6. Severe mental disorders.
7. Weak protective functions of the body.
8. AIDS.

Surgical treatment is possible if the patient's condition is satisfactory. Otherwise, there may be a risk of death.

Diagnosis before prescribing a transplant

Before identifying the possibility of surgical intervention and cases involving transplantation, a complex of examinations is carried out. The study includes the following diagnostic measures:

• analysis to determine blood type;
• electrocardiogram;
• blood test at the biochemical level;
• cardiac muscle, peritoneum;
• serological blood test;
• urine and blood analysis;
• study of tissue compatibility antigens;
• X-ray of the sternum.

The patient sees a therapist, surgeon, gastroenterologist. Sometimes you will need to be examined by the following doctors:

• endocrinologist;
• cardiologist;
• gynecologist;
• dentist

Thanks to comprehensive diagnostics, it is possible to identify the threat of transplanted organ rejection. If all the indicators determined during the test period are normal, then the doctors plan a pancreas transplant and search for a donor.

Tissue collection is carried out from a living person and from someone who is declared brain dead.

How is the transplant surgery performed?

Based on the test results, general health, and how severely the pancreas is affected, the doctor will select a pancreas transplant intervention.

1. Surgery involves transplanting the entire organ.
2. Transplantation of the caudal or other lobe of the gland.
3. It is necessary to eliminate the organ and part of the duodenum.
4. Introduction of Langerhans cells intravenously.

When transplanting the entire pancreas, it is taken with part of the duodenum. However, the gland can be connected to the small intestine or bladder. If only a portion of the pancreatic gland is transplanted, then the surgical intervention consists of draining pancreatic juice. To do this, use 2 methods.

1. Blocking the exit channel using neoprene.
2. Drainage of organ juice into the small intestine or bladder. When the juice is dumped into a bladder, the risk of infection is reduced.

The pancreas, like the kidneys, is transplanted into the iliac fossa. The procedure is complex and long. The operation is often performed under general anesthesia, which reduces the risk of serious complications.

Sometimes, a spinal tube is installed, which provides pain relief after the transplant to alleviate the condition.

Surgical treatment of the gland in stages:

1. The donor is injected with anticoagulation medication through the uterine artery, then a preservative solution is used.
2. Next, the organ is removed and cooled using a cold saline solution.
3. A planned operation is being performed. The recipient is incised, then a healthy gland or lobe is transplanted into the area of ​​the iliac fossa.
4. Arteries, veins and the outlet channel of the organ are gradually combined.

If a patient experiences changes in kidney function due to diabetes, then a double operation is possible. This will increase the chances of a favorable outcome.

If the transplant is successful, the patient's carbohydrate metabolism will quickly return to normal, so he does not need to regularly inject insulin, replacing it with immunosuppressive tablets. Their use will prevent the transplanted pancreatic organ from being rejected.

Immunosuppressive therapy is carried out using 2-3 drugs that have different mechanisms of action.

Like any surgical solution to the problem, implantation can provoke the development of complications in diabetes that cannot be solved by medications.

1. Formation of an infectious phenomenon in the peritoneum.
2. The presence of fluid around the transplanted organ.
3. Development of bleeding of varying levels of intensity.

Sometimes, rejection of the transplanted gland occurs. This indicates the presence of amylase in the urine. This can also be detected by performing a biopsy. The gland will begin. During ultrasound examination it is almost impossible to detect it, since the organ has blurred edges.

Prognosis after transplant surgery

Surgical treatment for transplantation involves a long and difficult rehabilitation for the patient. At this time, he is prescribed immunosuppressive drugs so that the organ can take root well.

Is it possible to cure the pancreas after transplantation?

According to statistics, survival after a pancreas transplant is observed in 80% of patients, for a period of no more than 2 years.

If the pancreas was transplanted from a healthy donor, then the prognosis is more favorable, and almost 40% of patients live more than 10 years, and 70% of those who live no more than 2 years.

The introduction of body cells intravenously has not proven to be the best, the technique is now being finalized. The complexity of this method lies in the insufficiency of one gland to obtain the required number of cells from it.

The first attempts to transplant part of the gland were made back in the 19th century, but the first transplantation was carried out in 1966. It was performed at the University of Minnesota, USA, on a patient with diabetes mellitus. For a short period of time, doctors managed to achieve positive results and normoglycemia, but after 2 months tissue rejection, sepsis and death occurred.

Over the next 7 years, 13 similar operations were performed, and in only one of them the entire pancreas was transplanted. As for the results of these interventions, normal functioning of the gland after transplantation for one year was noted only once.

Modern medicine has made significant progress in the field of transplantation, but still pancreas transplantation is fraught with many difficulties. Its success cannot be compared with similar liver and kidney transplant operations.

Transplantation of this organ can only be performed under very strict indications.

Indications

This operation can be performed if there are certain indications, among which the following can be noted:

All of the above indications are often very contradictory and the question of organ transplantation is decided by the doctor in each specific case. Pancreas transplantation is a very complex technical operation; in addition, there are certain contraindications to its implementation.

Contraindications

1. In the presence of malignant formations.
2. If there are serious diseases of the heart and blood vessels with severe cardiovascular insufficiency.
3. After suffering a cerebral stroke.
4. There are lung diseases.
5. Infectious diseases, including the presence of purulent foci of infection in the body.
6. Mental illnesses.

Operation technique

For transplantation, either the entire gland or a separate part of it (usually the body and tail) can be used. When transplanting the entire pancreas, it is taken together with a section of the duodenum. In this case, it may connect to the small intestine side to side or to the bladder. If only a segment of the gland is transplanted, then there are two ways to drain pancreatic juice.

In the first option, the excretory duct is blocked using neoprene. Any other synthetic quick-hardening material may also be used. But this method is not very popular in practice.

More often they use another option. It involves the drainage of gland juice into the bladder or small intestine. If the juice is drained into the bladder, then the likelihood of developing an infection is significantly reduced. Its development can be judged by a urine test, which will also show if a rejection reaction of the transplanted organ begins. But the connection with the bladder also has a disadvantage, namely that in this case, along with pancreatic juice, a noticeable loss of bicarbonates occurs.

Possible complications

Like any surgical intervention, transplantation entails
represents the likelihood of developing certain complications. Among them are the following:

• development of the infectious process;
• possible accumulation of fluid around the graft;
• bleeding.

Rejection of a transplanted gland can be judged by various
signs. If a connection has been made to the bladder, a urine test for amylase will provide information. A biopsy can also be performed through a cystoscope.

If the operation is successful, then normalization of carbohydrate metabolism is noted, and there is also no need for insulin administration. But to maintain metabolic processes, the administration of immunosuppressive drugs is required.

Useful video about pancreatic surgery