28 May, 2012


Pancreatic transplant


A pancreas transplant is a surgical procedure to place a healthy
pancreas from a deceased donor into a person whose pancreas no longer
functions properly. Almost all pancreas transplants are done to treat
cases of type 1 diabetes.

Your pancreas is an organ that lies behind the lower part of your
stomach. One of its main functions is to make insulin, a hormone that
regulates the absorption of sugar (glucose) into your cells. Type 1
diabetes results when your pancreas can't make enough insulin, causing
your blood sugar to rise to dangerous levels.

The side effects of a pancreas transplant can be significant, so a
pancreas transplant is typically reserved for those who have serious
diabetes complications. A pancreas transplant is often done in
conjunction with a kidney transplant.

why it is done??

A pancreas transplant offers a potential cure for type 1 diabetes, but
it's not a standard treatment. Often the side effects of the
anti-rejection medications required after a pancreas transplant can be
serious. But if you have any of the following, a pancreas transplant
may be worthwhile:
Type 1 diabetes that can't be controlled with standard treatment
Frequent insulin reactions
Consistently poor blood sugar control
Severe kidney damage

Because type 2 diabetes occurs due to the body's inability to use
insulin properly — and not because of a problem with insulin
production in the pancreas — a pancreas transplant isn't a treatment
option for most people with type 2 diabetes.

If you have severe kidney damage due to type 1 diabetes, a pancreas
transplant may be combined with a kidney transplant or be done after
successful kidney transplantation. This strategy aims to give you a
healthy kidney and a pancreas that's unlikely to contribute to
diabetes-related kidney damage in the future.

Risks involved

Complications of the procedure
Pancreas transplant surgery carries a risk of significant
complications, including:
Blood clots
Excess sugar in your blood (hyperglycemia)
Urinary complications, including leaking or urinary tract infections
Failure of the donated pancreas
Rejection of the donated pancreas

Anti-rejection medication side effects
After a pancreas transplant, you'll take medications for the rest of
your life to help prevent your body from rejecting the donor pancreas.
These medications can cause a variety of side effects, including:
Bone thinning
High cholesterol
High blood pressure
Skin sensitivity
Weight gain
Swollen gums
Excessive hair growth

how do you prepare??

Choosing a transplant center
If your doctor recommends a pancreas transplant, you'll be referred to
a transplant center. You're also free to select a transplant center on
your own or choose a center from your insurance company's list of
preferred providers.

When you consider transplant centers, you may want to:
Learn about the number and type of transplants the center performs each year
Ask about the transplant center's organ donor and recipient survival rates
Compare transplant center statistics through the database maintained
by the Scientific Registry of Transplant Recipients
Consider additional services provided by the transplant center, such
as support groups, travel arrangements, local housing for your
recovery period and referrals to other resources

After you've selected a transplant center, you'll need an evaluation
to determine whether you meet the center's eligibility requirements
for a pancreas transplant.

When the transplant team assesses your eligibility, they'll consider
the following.
Are you healthy enough to have surgery and tolerate lifelong
post-transplant medications?
Do you have any medical conditions that would hinder transplant success?
Are you willing and able to take medications and advice as directed?

If you need a kidney transplant, too, the transplant team will also
determine if it's best for you to have the pancreas and kidney
transplants during the same surgery, or a kidney transplant first,
followed by the pancreas transplant at a later date. The best option
depends on the severity of your kidney damage, the availability of
donors and your preference.

Once you've been accepted as a candidate for a pancreas transplant,
your name will be placed on a national list of people awaiting a
transplant. The waiting time for a transplant depends on your blood
group and how long it takes for a suitable donor — one whose blood and
tissue types match yours — to become available.

Staying healthy
Whether you're waiting for a donated pancreas to become available or
your transplant surgery is already scheduled, it's important to keep
your mind and body healthy.
Take your medications as prescribed.
Follow your diet and exercise guidelines.
Keep all appointments with your health care team.
Stay involved in healthy activities, including relaxing and spending
time with family and friends.

If you're waiting for a donated pancreas, make sure the transplant
team knows how to reach you at all times and arrange transportation to
the transplant center in advance.

what you can expect?

During a pancreas transplant
Surgeons perform pancreas transplants during general anesthesia, so
you're unconscious during the procedure. The anesthesiologist or
anesthetist gives you an anesthetic medication as a gas to breathe
through a mask or injects a liquid medication into a vein.

The surgical team monitors your heart rate, blood pressure and blood
oxygen throughout the procedure with a blood pressure cuff on your arm
and heart-monitor leads attached to your chest. After you're
An incision is made down the center of your abdomen.
The surgeon places the new pancreas and a small portion of the
donor's small intestine into your lower abdomen.
The donor intestine is attached to either your small intestine or
your bladder, and the donor pancreas is connected to blood vessels
that also supply blood to your legs.
Your own pancreas is left in place to aid digestion.
If you're also receiving a kidney transplant, the blood vessels of
the new kidney will be attached to blood vessels in the lower part of
your abdomen.
The new kidney's ureter — the tube that links the kidney to the
bladder — will be connected to your bladder. Unless your own kidneys
are causing complications, such as high blood pressure or infection,
they're left in place.

Pancreas transplant surgery usually lasts about three hours.
Simultaneous kidney-pancreas transplant surgery takes a few more

After a pancreas transplant
After your pancreas transplant, you can expect to:
Stay in the intensive care unit for a few days. Doctors and nurses
monitor your condition to watch for signs of complications. Your new
pancreas should start working immediately, and your old pancreas will
continue to perform its other functions. If you have a new kidney,
it'll make urine just like your own kidneys did when they were
healthy. Often this starts immediately. But in some cases, urine
production takes up to a few weeks.
Spend about one week in the hospital. Once you're stable, you're
taken to a transplant recovery area to continue recuperating. Expect
soreness or pain around the incision site while you're healing.
Have frequent checkups as you continue recovering. After you leave
the hospital, close monitoring is necessary for three to four weeks.
Your transplant team will develop a checkup schedule that's right for
you. During this time, if you live in another town, you may need to
make arrangements to stay close to the transplant center.
Take lifelong medications. You'll take a number of medications after
your pancreas transplant. Drugs called immunosuppressants help keep
your immune system from attacking your new pancreas. Additional drugs
may help reduce the risk of other complications, such as infection and
high blood pressure, after your transplant.


After a successful pancreas transplant, your new pancreas will make
the insulin your body needs, so you'll no longer need insulin therapy
to treat diabetes. But even with the best possible match between you
and the donor, your immune system will try to reject your new
pancreas. So you'll need medications to suppress your immune system.
You'll likely take these or similar drugs for the rest of your life.
Because medications to suppress your immune system make your body more
vulnerable to infection, your doctor may also prescribe antibacterial,
antiviral and antifungal medications.

Pancreas transplant survival rates
According to the Organ Procurement and Transplantation Network,
transplanted pancreas and kidney survival rates include the following.
Simultaneous pancreas-kidney transplant. In about 87 percent of
people who receive a simultaneous pancreas-kidney transplant, the
transplanted pancreas is still functioning after one year. After five
years, that rate is about 72 percent.
Pancreas-after-kidney transplant. In about 77 percent of people who
receive a pancreas-after-kidney transplant, the transplanted pancreas
is still functioning after one year. Five years after transplant, the
rate is about 59 percent.
Pancreas-only transplant. In about 85 percent of people who receive a
pancreas-only transplant, the transplanted pancreas is still
functioning after one year. After five years, that rate is about 52

It's unclear why results are better for those who receive a kidney and
pancreas at the same time. But some research suggests it may be
because it's more difficult to monitor and detect rejection of a
pancreas alone, versus a pancreas and a kidney.

If your new pancreas fails, you can resume insulin treatments and
consider a second transplant. This decision will depend on your
current health, your ability to withstand surgery and your
expectations for maintaining a certain quality of life.

Courtesy - Mayo clinic.

From 296 B.C till date... the path we travelled!

This topic might not excite many... When everybody is trying to talk about future modalities of treatment why did i choose to travel back in time... well the answer is simple. we were the first ppl to introduce diabetes to the world. current situation is that we leadin Diabetes in tems of numbers. Diabetes has become a noncommunicable epidemic in our country. To retrace the path our ancestors followed and to understand how our present day understanding of modern medicine has evolved in truly fascinating!!!!!!!

Diabetes is a disease of worldwide distribution. Initially it was thought that diabetes is a disease of the affluent. But recent studies have shown that prevalence of diabetes is same among the rich and poor. It affects the urban and rural population alike. The earliest mention of Diabetes is seen during the vedic period. Among the Vedas, Atharva veda deals with medicine. During this period Diabetes was referred by two terms
1)Asrava means to flow. From here a new term “Mutratisara” evolved which meant excessive urination
During 321-296B.C Kautilya who was considered as a Father of diplomacy has mentioned a method to produce Diabetes in his book Arthesastra. According to him burnt chameleon and lizard combined with intestines of frog & honey if administered can cause diabetes.

After the vedic period more accounts of Diabetes are recorded in chararka samhita. These accounts are supposed to have been written in about 600B.C. This explains more about the etiology including heredity, pathogenesis, symptoms, complications and methods of treatment in detail. Here in these accounts the etiology of diabetes is mentioned as
· Overnutrition
· Lack of exercise
· Undernourishment with excessive labour
In this account the inherited diabetes was considered incurable.
Pathogenesis was considered to be derangement of “meda”, “mamsa” & “kleda”. The main point is that in this account it is a point of historical importance that the book mentions the loss of sweet substance in urine.
One more book to document diabetes is bhela samhita. This book documents two types of diabetes
Prakrti prabhava (congenital)
Svarakta (Acquired)

Susrutha followed the same classification and he concluded that the congenital variety of diabetes was caused by defect in” bija” (reproductive units – sperm & ovum) and the acquired variety is due to heavy diets and luxurious lifestyle.

Susrutha contributed a separate chapter for treatment of Diabetes and he also described management of carbuncles.
After susrutha Bhagbatta was a great contributor to the field of Medicine. He explained two types of Diabetes based on the pathogenesis.one is “dhatuksaya (thin diabetes) and other is avarana janya (obese diabetes)
The medieval period was only collections of previous works. No great information was added to the already known facts

In the 16th century Bhavamisra contributed to history of Diabetes by adding some new vegetable and metallic preparations for management of Diabetes. After this time our country fell into the hands of foreign rulers and Indian culture and Aryan civilization was affected by foreign rulers and their policies to abolish the Aryan civilization. During the British rule the schools of Indian medicine were replaced by the western system. The whole events resulted into a big stagnation and gap in the evolution of this system.
The moderm Medicine evolved with Chinese medicine and explained the syndrome of 3P’s (polyphagia, polyuria & polydipsia) the study of chemistry of urine was initiated by Paracelsus in the 16th century. It took nearly hundred years to identify the sweet material as glucose. This discovery led to rational dietary approach.

Morton in 1686 noted the hereditary nature of diabetes

Paul langerhans working in Berlin reported in 1868 a type of cells in the pancreas which lie together in considerable number and these were later named islets of langerhans and are still known by his name
The work of great clinicians like Bouchardt, Naunyn, Von Noorden, Allen and Joslin led to significant therapeutic success with diet.
Von mering & Minkowski ‘s studies in 1889 demonstrated that dogs can be made diabetic by pancreatectomy. After 30 years of tiring work Banting & best were able to produce extract from dog pancreas which was capable of reducing elevated blood glucose level.
1939 à Hagedorn introduced the first long acting insulin.
1953 à structure of OX insulin established by Sanger
1955à experimental work lead to accidental discovery of hypoglycaemic action of Carbutamide
1960 à Nicol and Smith described the structure of Human insulin
1964à Katsoyannis and Zahn synthesised both A and B chains of insulin
1967 à Steiner described large proinsulin molecule which is not biologically active but is converted to biologically active substance by enzymatic action.

Note - i would like to place on record my heartfelt gratitude to Upadhayay and Mrs D.Upadhyay for their article "A few facts of historical interest relating to Diabetes Mellitus" published in Indian journal of history of science published in 1987.

26 May, 2012

One Question..

Most of the doctors prefer to scribble down some multivitamin or antioxidant for every diabetes prescription. your take on this??