Pancreas transplantation

The pancreas is a complex organ, which has a dual function. First, it produces digestive enzymes - this is the exocrine function. Secondly, in this gland hormones that participate in carbohydrate metabolism are synthesized, the endocrine function. Violations and disorders can be noted as one or the other function. In some cases, the gland tissue is completely turned off from the process and ceases to perform its function. Therefore, sometimes the question arises about a surgical procedure in order for a pancreas transplant to be performed.

History of

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

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

Modern medicine has achieved significant success in the issue of transplantation, but nevertheless pancreas transplantation is fraught with many difficulties. The success of its conduct can not be compared with similar operations on liver and kidney transplantation.

This organ can be transplanted only after very strict indications.

Indications

You can perform this operation if there are certain indications, among which you can note the following:

1. Diabetes mellitus type 1 and type 2.
2. Secondary diabetes, which can develop for several reasons:
   • due to damage to the gland tissue( eg, pancreatitis);
   • for hormonal disorders that led to the body's resistance to insulin( here Cushing's syndrome, gestational diabetes, acromegaly);
     
3. Hyperlabile diabetes.
4. Nephropathy in the final stage. Endocrine and exocrine gland failure.
5. .
6. Diabetic nephropathy.

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

Contraindications

It is not recommended to transplant this organ in the following cases.

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

Procedure for the operation

For transplantation, both the whole gland and its individual part( most often the body and tail) can be used. When transplanting the entire pancreas, it is taken together with the site of the duodenum. In this case, it can connect with the small intestine laterally or bladder. If only the gland segment is transplanted, then there are two ways of removing pancreatic juice.

In the first variant, the outlet duct is blocked by neoprene. Also, some other synthetic quick-setting material can be used. But this method is not very popular in practice.

More often use another option. It involves removing the juice of the gland into the bladder or small intestine. If the juice is diverted into the bladder, then the probability of infection is markedly reduced. One can judge its development by analyzing the urine, which will also show if the rejection reaction of the transplanted organ begins. But the connection with the bladder has a minus, which is that in this case, along with pancreatic juice, there is a noticeable loss of bicarbonates.

Possible complications

Like any surgical procedure, transplantation entails
for the possibility of developing any complications. Among them are the following:

• development of the infectious process;
• fluid may accumulate around the graft;
• bleeding.

It is possible to judge the rejection of the transplanted gland according to various
signs. If a connection to the bladder was made, then the information will give an analysis of urine for amylase. You can also perform a biopsy through a cytoscope.

If the operation is successful, then normalization of carbohydrate metabolism is noted, and the need for insulin administration is also eliminated. But to maintain metabolic processes requires the introduction of immunosuppressive drugs.

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