Most people treat type 1 diabetes with insulin shots and diet changes. But what happens when your blood sugar levels are out of control, even when you’re doing everything right? Your doctor may recommend a pancreas transplant to restore your body’s ability to make insulin. If the procedure is successful, you will not need insulin.

In this article, we’ll talk about pancreas transplants, how they work, and their side effects. To learn more about this procedure and whether you or your child is eligible, talk to a doctor or pediatrician.

What Is a Pancreas Transplant, and How Does It Treat Type 1 Diabetes?

The pancreas is the organ responsible for making insulin. This hormone helps control your glucose (blood sugar) levels. Type 1 diabetes is an autoimmune disease — meaning the immune system attacks and damages the pancreas. If the pancreas can’t make enough insulin, your glucose levels rise out of control.

Most people with type 1 diabetes take insulin injections and watch their diet to keep their blood sugar in a healthy range. However, standard treatments may not work for everyone. Doctors can choose to perform a pancreas transplant for some people with type 1 diabetes.

A pancreas transplant involves taking a healthy, functioning pancreas from a donor who has died (deceased donor). The donor pancreas is then placed into the lower right side of the abdomen or stomach area of the person getting the transplant. The transplant surgeon connects blood vessels from the donor pancreas to the person’s blood vessels.

The donor pancreas also comes with some of the donor’s upper small intestine. This portion of their intestine is attached to either the intestines or the bladder of the person receiving the donor pancreas. The original pancreas stays in place and isn’t removed. This is so it can continue making substances needed for digestion.

Overall, a pancreas transplant takes about three hours to complete.

Who’s Eligible for a Pancreas Transplant?

Not everyone with type 1 diabetes is eligible for a pancreas transplant. Your doctor will explain whether you’re a candidate.

Pancreas transplants are typically reserved for people with uncontrolled type 1 diabetes and organ damage. This means your blood sugar levels can’t be controlled properly, even with medications and lifestyle changes.

People with type 1 diabetes can experience very high and very low blood sugar. A transplant may be best for someone who frequently deals with hypoglycemia, or low blood sugar levels. Hypoglycemia can be extremely dangerous if left untreated.

You also may receive a pancreas transplant for reasons such as these:

• You have organ damage due to diabetes that has affected your eyes, kidneys, or nerves.
• You have reactions to insulin treatments.
• You’re generally in good health and don’t have blood vessel or heart disease.

Some people with type 2 diabetes may also be eligible for a pancreas transplant. To qualify for a pancreas transplant, you need to have low insulin production and low insulin resistance. Mayo Clinic notes that only 15 percent of these transplants happen in people with type 2 diabetes.

Pancreas and Kidney Transplants: What’s the Connection?

High blood sugar levels from uncontrolled type 1 diabetes affect many of your body’s organs, including the kidneys. In fact, kidney disease is a common but serious complication of the condition. Diabetes damages the tiny filters in the kidneys, stopping them from filtering waste.

If kidney damage is bad enough, you may need a kidney transplant. Many transplant teams perform pancreas and kidney transplants at the same time. We’ll discuss these procedures more below.

Types of Pancreas Transplants

The type of pancreas transplant you have depends on your overall health, how healthy your kidneys are, and what organs become available.

People who have healthy kidneys or early kidney disease may have a pancreas transplant alone. In this procedure, you receive a healthy pancreas from a donor.

If you have both type 1 diabetes and kidney disease (or kidney failure), your transplant surgeon will likely recommend a combined kidney-pancreas transplant. This is the most common procedure. A combined transplant gives you a healthy pancreas and kidneys, which lowers the risk of developing diabetes-related kidney problems later on.

Some people wait months or years on organ transplant lists for a matching donor. If you need both kidneys and a pancreas, the wait can be even longer. Your transplant surgeon may perform a pancreas-after-kidney transplant if healthy kidneys become available first. Once you recover from that surgery, you’ll be ready to receive a donor pancreas in a second surgery.

Outcomes are better for simultaneous pancreas-kidney transplantation than for a pancreas transplant alone or a pancreas-after-kidney transplant, according to the British Transplantation Society. These procedures should be done at centers with expertise in transplantation and diabetes management.

Clinical Trials for Islet Cell Transplant

Doctors and researchers are always looking for new ways to treat type 1 diabetes. Large studies called clinical trials are investigating a new treatment known as pancreatic islet transplants. Islet cells are responsible for making insulin. In an islet transplant, a health care provider injects islet cells from a donor into a blood vessel that leads to the liver.

This approach isn’t approved by the U.S. Food and Drug Administration (FDA) yet. The only way to try an islet cell transplant is through an eligible study.

What Are the Risks of a Pancreas Transplant?

A pancreas transplant involves major surgery and has a risk of complications. Potential complications include:

• Bleeding or blood clots
• Infections at the surgical site
• Failure of the new pancreas, meaning it doesn’t work as expected
• Urinary problems, including urinary tract infections or leaking urine
• High blood sugar levels
• Pancreatitis (inflammation of the pancreas)

Organ Rejection and Antirejection Medications

Organ transplants also carry a risk of organ rejection and infections from medications. Your immune system recognizes your organs as your own. When you receive a transplant from another person, your body may think the new organ is a foreign invader.

Your doctor will prescribe medications known as immunosuppressants to dampen your immune system. These drugs prevent your body from attacking and rejecting the transplanted pancreas.

After a pancreas transplant, you’ll take immunosuppressants for the rest of your life. These medications stop your immune system from working properly, so you’re more likely to get infections and become sick. Other side effects of antirejection medications include:

• High cholesterol and blood pressure
• Bone thinning and osteoporosis (disease that weakens bones)
• Nausea, vomiting, and diarrhea
• New hair growth or loss
• Weight gain and puffiness
• Acne

Some immunosuppressants also raise your risk of developing certain types of cancer, such as skin cancer. This is because the medications make your skin more sensitive to the sun. Your immune system also has a harder time finding and destroying cancer cells when you take immunosuppressants.

What Are the Outcomes of a Pancreas Transplant?

If your pancreas transplant is successful, your new pancreas will make insulin, so you won’t need to use insulin therapy anymore. This helps control your blood sugar levels and lowers your risk of high and low swings.

Overall, the outlook after a pancreas transplant is good. According to Johns Hopkins Medicine, people who receive both a pancreas and kidney transplant are less likely to experience organ rejection.

You’ll need to continue checking in with your doctor and taking antirejection medications. It’s important to keep an eye on your blood sugar levels over time as well.

Pancreas transplants don’t last forever. They may last a decade or longer — or less, depending on many factors, including the health of the donor. You may need tests every few years to check how well your transplanted pancreas is working. According to the British Transplantation Society, 95 percent of people are insulin-independent one year after transplant, and 65 percent to 70 percent are insulin-independent at five years.

What Happens if Your Pancreas Transplant Fails?

Not every pancreas transplant is successful. Your body may reject the new pancreas, and the transplant might fail. If this is the case, you’ll go back on insulin therapy to control your blood sugar levels. Your transplant team may recommend trying another surgery if you’re in good health and can tolerate it.

Find Your Team

On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 3,400 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Have you or your child had a pancreas transplant for type 1 diabetes? Was the treatment successful? Share your experience in the comments below, or start a conversation by posting on your Activities page.