A Godsend for People with Severe Diabetes

he pancreas is a finicky organ to replace, asserts transplant surgeon Dilip S. Kittur, M.D., Sc.D. First of all, it inflames easily when transplanted, and second the enzymes in its secretions can cause pancreatitis or erosion of the tissues where the gland drains. Specialists like Kittur and his colleague Warren Maley, M.D., however, have learned how to get around such roadblocks and now can make an incredible difference to one group of very sick patients—those with severe, insulin-dependent diabetes between the ages of 30 and around 60—by providing them with a new pancreas. Thanks to rapid advances in surgical techniques, people in renal failure, suffering from end-stage neuropathy and having difficulty controlling their blood sugar, a pancreas transplant can be a godsend, Kittur says.

Sixty-one-year-old physician Dean Taylor can testify to that. An interventional cardiologist with type I diabetes, his vision had failed to the point where he could no longer practice medicine, his kidney function had deteriorated, and peripheral neuropathies were causing him relentless pain and tingling in his extremities when he received word last year that Hopkins had a donor pancreas for him. Today, one replacement organ later, he says, “I have a whole new life.” The pain has disappeared, his vison has stabilized, and he no longer is on kidney dialysis.

Maley, who takes over directorship of the program from Kittur in July, talks about the changes that have increased the procedure’s graft-survival rate to almost 100 percent: Surgeons now drain secretions from the transplanted pancreas into the bladder (or the small bowel), he explains, and the donor’s duodenum is transplanted along with the pancreas, thereby decreasing the likelihood of insufficient blood flow to the organ and leakage. In most cases, a donor pancreas and kidney also will be simultaneously transplanted, because research has shown that the kidney is an excellent monitoring device for rejection. Finally, new preservatives have improved the storage of organs, and doctors have become better at diagnosing pancreas rejection.

Says Kittur: “There’s a day-and-night difference in the lives of the patients who have these transplants. The rigors of the diabetic lifestyle go away, and since patients no longer suffer from diabetes, there is no more need for daily insulin injections, monitoring blood sugar or even maintaining a controlled diet.”

—Helen Montag