Diabetes is increasing at a rate even beyond what one would have predicted ten years ago. Diabetes harms the pancreas, the organ which normally produces insulin to keep glucose (sugar) under control. Both Type I diabetes (which results in a complete lack of insulin production) and Type II diabetes (resulting in little or no insulin production) are growing worldwide. “Increasingly, diabetes is appearing more and more around the world, among every population. African-Americans and Hispanic populations show marked increases in diabetes. Patients in their thirties and forties are now developing what used to be called juvenile diabetes. Studies show that these changes are statistically significant - that the increasing rate of diabetes is a big problem,” says Dr. J. Keith Melancon (pronounced Milan-SAN), Director of Kidney and Pancreas Transplantation.
All of the tissues in the body are affected by diabetes. When diabetes causes the pancreas to function improperly, the enzymes (proteins) that normally break down food in the pancreas are released into the body and start to break down the body’s other tissues. Because of this, diabetes can lead to vision impairment, nerve damage, coronary artery disease and kidney disease. Unfortunately, the trend in the U.S. is that there are more people awaiting transplantation every year. According to UNOS (as of May 20, 2005) there are currently 1,708 individuals awaiting pancreas transplantation and 2,463 individuals awaiting pancreas and kidney transplantation.
Dr. Melancon remarks that there have been a number of medical advances since the first pancreas transplant was performed in 1966, “Over the decades, pancreas transplantation outcomes have greatly improved. In the late 1980’s a pancreas at 1-year post-transplant could have an 42% function rate, now, it is closer to 90%. Transplanted pancreases are lasting longer because techniques are better and the immunosupression is better.”
Dr. Melancon has specialized in how pancreas transplantation, often paired with kidney transplantation, can be used as a treatment option for some diabetic patients. He anticipates that in the next ten years, we will also see advances in new areas of transplantation, such as infusions of pancreatic islet cells (the cells which produce insulin) and possibly stem cell transplantation. While the experiences with islet cells to date have been frustrating, the advantages of injecting a patient with new islet cells (and sparing them the transplant operation) will keep our scientists working toward this as a possibility. Scientists still have to conquer the episodes of islet cell rejection, just like in whole organ transplantation. At the same time, stem cell research is also incredibly promising. Antigens in stem cells would not be expressed in the same way as on islet cells, and the body would be more tolerant. “What we are working for, in the end, is the same – a higher quality of life for individuals suffering from diseases such as diabetes,” says Dr. Melancon.
Dr. Melancon joined our surgical team in mid-2004. For transplant evaluation information, call 410-955-5045 (option 1).
