Can You Get a Pancreas Transplant for Type 1 Diabetes?

If you have type 1 diabetes, you may have wondered if a pancreas transplant could cure your condition.

In fact, for a select group of people with advanced complications, a pancreas transplant may be an option, offering independence from insulin treatment and fewer blood sugar fluctuations. But these surgeries are extremely rare. This type of transplant is not a first-line treatment for diabetes and is generally not considered to be a cure. Eligibility requirements are strict, and post-surgery risks are significant, potentially even outweighing the downsides of life with type 1.

“Transplant is not a cure — it’s a treatment,” says Charles Bratton, MD, a transplant surgeon from Loma Linda University Health in Loma Linda, California. “The question is whether that treatment gives you a better life than the disease itself.”

• Donor criteria are strict, and pancreases must come from otherwise healthy donors, usually younger than 60 years old.
• A full pancreas must come from a person who has recently died.
• The pancreas itself is a particularly fragile organ, Dr. Bratton says. It may be damaged when removed from the donor.
• Transplant risks may outweigh benefits for many people with type 1 diabetes.

“Endocrinologists know how to manage diabetes with insulin and pumps, so they don’t refer people for a transplant,” he says.

This change can be so dramatic, Bratton says, that transplant recipients sometimes have a tough time trusting that their new pancreas will take over the nonstop work of blood sugar management.

“The first thing they notice right away is that they wake up and their blood sugars are perfectly normal,” Bratton says.

Pancreas transplants also come with significant risks, from the surgery itself to the need for immune system suppression to protect the transplanted pancreas.

• Surgical Risks These may include bleeding, infection, intestinal blockage, and fluid buildup, which may require more care, possibly including additional surgeries.

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• Organ Rejection About 10 to 15 percent of pancreas transplants fail within the first year.

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• Short-Term Impact About 30 percent of recipients need to use at least some insulin after three years.

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• Long-Term Transplant Risks These may include a heightened risk of infections and cardiovascular problems.

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   About 43 percent of transplanted pancreases also do not last more than 10 years.

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• Medication Side Effects Antirejection medications can cause weight gain, high blood pressure, and infections.

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The volume of follow-up medications can also be large, says Ali Dugger, 40, who received a pancreas transplant at age 39 at the Loma Linda University Transplant Institute in Loma Linda, California. She says she takes handfuls of pills at specific times each day to prevent her immune system from attacking the new organ.

“Nearly a year out, I’m still having my labs drawn every two weeks,” she says. “It’s not just losing your organs that can kill you. It’s the suppressed immune system — things you’ve never heard of. Raking dead leaves could land you in the hospital with a fungal infection. Swimming in a lake could make you septic. Even a vitamin with immune-boosting herbs like echinacea could send you into organ rejection.

“(The transplant) enables you to live, but it comes with even more rules than type 1 diabetes.”

“Pancreas transplantation on top of kidney transplantation will actually improve and extend your life even further,” Bratton says. “The kidney protects the pancreas. It increases your ability to survive and reduces rejection.”

The two transplants may occur at the same time or in separate procedures.

Pancreas transplants are usually only performed on people who have extreme diabetes management challenges, such as repeated bouts of diabetic ketoacidosis (DKA) or severe hypoglycemia.

Bratton says you may be eligible for a pancreas transplant if you have:

• End-stage kidney disease caused by type 1 diabetes
• Severe hypoglycemia unawareness, or the inability to spot symptoms of dangerously low blood sugar
• “Brittle” diabetes, an unofficial diagnosis that refers to extreme blood sugar swings.

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• Heart disease
• Significant insulin requirements
• Obesity
• History of excessive use of alcohol, tobacco, or drugs
• Other restricting medical conditions, including many types of cancer and immunodeficiencies

Dugger says that she passed “tests for my heart, bladder, bones, and mental health” before her transplant and that she also needed to prove she had “two dependable caregivers” to help her with surgery recovery.

“Modern man-made islet cells require significantly fewer donors,” Bratton says. “It’s not perfect. But diabetes is devastating, and that’s why research continues.”

• Pancreas transplants offer a potential option for insulin independence in some people with severe complications of type 1 diabetes.
• Although the transplants can significantly improve quality of life, the procedure carries serious risks, including the possibility of organ rejection and the need for immune-suppressing medications.
• Only about 100 pancreas-alone transplants occur in the United States each year. Simultaneous kidney and pancreas transplants, for people with kidney disease and diabetes, are more common.
• Alternative options like islet cell transplants may provide benefits, though this surgery is not commonly performed yet.