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I'm Niraj Desai, I'm a transplant surgeon here at Johns Hopkins, in the
department of surgery, and I'm the director
of the kidney and pancreas transplant program.
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The pancreas transplant operation is done through an abdominal mid-line incision.
And that is an up and down incision on the abdomen.
We connect the artery and the vein that both supply the
blood to the pancreas and return the blood back to the body.
And then once we allow the blood flow into the
pancreas, we have to connect a small piece of intestine
that comes with the pancreas organ to the patient's intestine
to allow drainage of the excrement material into the patients body.
Previously, people would connect that to the bladder, but we really don't do that
procedure anymore, because the patients tolerate it
being connected to the intestines much better.
It, it's not associated with long-term
complications like connecting it to the bladders.
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The combined kidney and pancreas transplant operation
is done through an abdominal mid line incision
and we, and that is an incision that runs up and down on the abdomen.
And we place the kidney and the pancreas
in, almost like two different operations in the abdomen.
Typically, we'll put the kidney in first, allow the blood
flow back into the kidney and let it start working.
And then in a separate location, but
through the same incision put the pancreas in.
So the patient wakes up having had two operations done on the
inside, but through one incision and
both organs are hopefully functioning immediately.
They're making urine.
The creatinine is coming down, reflecting kidney function and
the pancreas is making insulin and the glucoses become normal.
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Pancreas after kidney, transplant operations, would
be two separate operations, done through two
different incisions, two different hospital stays and,
of course, two, independent recoveries as well.
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With the pancreas transplant alone, the quality of
life is primarily focused upon normalizing someone's glucose control.
Patients who are typically undergoing a pancreas-alone transplant have a very
difficult quality of life from extreme
difficulties in controlling their blood sugars.
So they'll run from being very low and having hypoglycemia, which can lead to,
passing out, or seizures, having to call for emergency help, problems like that.
And then, alternatively, swings toward the high end, where they end up with very
high glucoses, and have to end up
being hospitalized for control of their diabetes.
When the pancreas is successful, all of their glucoses should become normal, and
they avoid both the lows and the highs and have excellent glucose control.
Long term the advantage of that is that complications from diabetes, what
we refer to as secondary complications are either reversed or minimized.
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Quality of life after the combined procedure is fantastic.
These individuals come in with two problems, kidney
failure or most of the time on dialysis and
a very long period of time of having been
diabetic, taking insulin, having
difficulties with controlling their glucoses.
And after the single operation, both of
those problems are fixed, so they feel fantastic.
They're no longer on dialysis or impending about to go on.
They no longer have to take insulin and having
swings in their blood sugars and having normal control.
So we fix the kidney problem, we fix their diabetes, and
when this works well it is an outstanding result for the individual.
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So individuals that receive a pancreas transplant can expect the
organ to often last for 10 years or more, on average.
It is a very durable therapy.
It is able to function for many, many years when the
patient is compliant and especially when early rejection episodes are avoided.
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Even from a deceased donor, the combined operation it is probably mostly a function
of us being able to monitor the kidney, to pick up on problems related to rejection.
It's hard to track rejection of the pancreas,
whereas it's easier to track rejection of the kidney.
So if you have both organs in, you can follow the kidney quite easily and know
that there's a trouble and increase the immunosuppression
if there's rejection, and treat both, in both organs.
It tends to correlate, so if you're having rejection in the kidney, you're typically
having rejection in the pancreas, and that's
at least an 80% correlation for those two.
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So initially after the operation is done, patients spend at least a
week in the hospital and often a couple of weeks in the hospital.
Once someone goes home, they are getting labs drawn
twice a week usually close to home and coming
back for outpatient visits on a weekly basis and
then every other week and then once a month.
And for the first couple of months, they're
back here for out patient visits fairly frequently.
But once times goes on, they're able to just follow up every three months, but
still getting labs twice a week, then once
a week, every other week, and then monthly.
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So long term follow up which I would say is after the first year, patients are
seen once every three months in a doctor's
office appointment and get labs drawn once a month.
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Patients come to Hopkins to look into a pancreas transplant for several reasons.
One, there's a big team of people here
that are dedicated to taking care of transplant patients.
The expertise that these individuals bring is fantastic for
this patient population, and this includes surgeons, medical physicians,
nurse coordinators, nurse practitioners, everyone together has had a
lot of experience taking care of pancreas transplant patients.
And as a result that collective experience is great for
helping someone through the operative procedure, and the post-operative recover.
The second reason that patients come to Hopkins, to look into a pancreas
transplant is the experience that we have with taking care of sensitized patients.
These are individuals that have antibody in their
bloodstream, or often difficult to transplant, and the
experience that has been gained in both the
kidney and pancreas transplant populations that have antibody that
makes transplantation difficult, draws individuals here looking for
a chance at transplant when they haven't been
able to get that opportunity elsewhere, because of
these sensitization events they have undergone in the past.
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