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Presentation: Pancreas transplant procedure

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The pancreas sits in the back of the abdomen. It produces digestive enzymes which are delivered to the small intestine (duodenum), and various hormones, which are released into the bloodstream. One of the most important hormones produced by the pancreas is insulin. Insulin is produced by specialized cells of the pancreas called islets. Insulin regulates blood sugar levels.

One of the most common diseases which affects the pancreas is insulin dependent diabetes, or type I diabetes. Type I diabetes is the result of an autoimmune attack on the islet cells which produce insulin. The resultant lack of insulin leads to excess blood sugar levels in the blood and a variety of health problems, including visual disturbances (diabetic retinopathy), heart disease, nerve disorders (diabetic neuropathy), and kidney disease (diabetic nephropathy). To control their blood sugar, diabetic patients must take insulin injections everyday.

A pancreas transplant is a procedure in which a donor pancreas, obtained from a brain-dead organ donor who has been maintained on life support. The recipient's own diseased pancreas is left in place, and the donor pancreas is transplanted through a midline abdominal incision. In patients who have diabetes and kidney failure as a result of their diabetes, this operation is often done in combination with kidney transplant.

The donor duodenum, which remains attached to the donor pancreas, is attached to the recipient's small bowel, to allow the digestive enzymes produced by the donor pancreas to drain into the small intestine.

The vessels of the donor pancreas are attached to the vessels which supply the leg, located in the groin.

Recently, attempts have been made to isolate only the insulin producing islets from the donor pancreas, and infuse these islets directly into the bloodstream of diabetic patients, where they would lodge in the tissues and produce insulin. 'Islet transplantation' is still an experimental procedure, but it may someday offer a treatment for diabetes.

References

American Diabetes Association. Pancreas and islet transplantation in type 1 diabetes. Diabetes Care. 2006;29:935.

Pavlakis M, Khwaja K. Transplantation for type 1 diabetes: whole organ pancreas and islet cells. Curr Diab Rep. 2006;6:473-478.

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