When should pancreas transplant be considered

As donor pancreases are scarce, you'll need to be assessed carefully to determine whether a pancreas transplant is suitable for you and that you could benefit from one.

When pancreas transplants are considered

A pancreas transplant is usually only considered in a small number of cases of people with Type 1 diabetes .

There are around a million people in the UK with type 1 diabetes, but only about 200 get a pancreas transplant each year.

Type 1 diabetes occurs whenthe immune system destroys the cells (islets) in the pancreas that produce a hormone called insulin.

It can often be controlled with insulin injections, so the risks of a pancreas transplant outweigh the benefits in many cases.

However, a transplant may be considered if:

• you also have severe kidney disease ,whether it's caused by diabetes or not a pancreas transplant may be carried out alongside a kidney transplant in these cases
• you have severe episodes ofa dangerously low blood sugar level (hypoglycaemia) that occur without warning, in spite of good insulin control

If a healthy pancreas is transplanted into the body, it should start producing insulin, relieving any diabetes symptoms and replacing treatment with insulin injections.

Assessment for a pancreas transplant

A detailed assessment at a transplant centre is needed to find out more about your health, and check whether there are any underlying problems that could affect your suitability for a pancreas transplant.

This will usually involve having several tests, such as:

• checksof your blood pressure and heart rate
• measurements of your height and weight
• urine and blood tests
• a chest X-ray
• a Duplex scan a type of ultrasound scan used toexamine your blood vessels
• an echocardiogram an ultrasound scan of the heart
• an electrocardiogram (ECG) this measures the electrical activity of your heart
• cardiac catheterisation and coronary angiography a special type of X-ray used to study the inside of your heart

You'll also have the opportunity during your assessment to meet the transplant team and find out more about the procedure.

You may find it useful to write down a list of questions you would like to ask the transplant team before your visit.

Who might not be suitable for a pancreas transplant?

Unfortunately, not everyone who thinks they would benefit from a pancreas transplant will be suitable for one.

This is because the operation places a major strain on the body, and may mean the risks outweigh the potential benefits.

For example, you may be considered unsuitable for apancreas transplant if you:

• have severe coronary heart disease
• have recently had a heart attack
• have incurable cancer
• have a serious mental health or behavioural condition that means you would be unlikely to be able to correctly take the medication needed after a pancreas transplant
• are generally in poor health and are unlikely to withstand the strain of surgery and the ongoing treatment that follows it
• are obese you may need to lose weight before a transplant is considered
• drink alcohol excessively or abuse drugs you may need to stop before a transplant is considered

Age isn't a factor in determining whether a pancreas transplant is suitable, althoughthe procedure israrely performed in older people because they often have other health problems that mean a transplant is too risky.

Decision to recommend a transplant

The final decision about whether you are suitable for a pancreas transplant is a joint decision made by the transplant team.

You may be informed about the decision before leaving the transplant centre. But if your case is not straightforward, it may be several weeks before you're told the decision.

The transplant team may decide you are:

• suitable for a transplant and ready to be placed on a waiting list read more about being on thepancreas transplant waiting list
• suitable for a transplant, but your condition doesn't require a transplant you'll usually be monitored in case your condition gets worse
• unsuitable for a transplant the reasons will be explained in detail by your transplant team

In some cases further tests are necessary to make a final decision, or you may be referred to a different transplant centre for a second opinion.