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Featuring Niraj Desai, Assistant Professor of Surgery
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.
It’s very satisfying to have patients that are in organ failure; in this situation, patients that have diabetes and to be able to do a operation that corrects diabetes, which they’ve often had for as long as they can remember – decades worth of being a diabetic and to be able to do a pancreas transplant and reverse that and give them back a fairly normal life. It is a very satisfying thing to see in a patient.
So patients need a pancreas transplant for the treatment of Type One diabetes, which is juvenile onset diabetes, and it is most commonly done in combination with a kidney transplant. So the typical scenario is someone who has had type one diabetes for many decades, as a consequence to that has developed kidney failure and then we commonly do the combined kidney and pancreas transplant for that individual.
So pancreas transplant alone is done for individuals with very brittle diabetes, it’s difficult to control with insulin either via injection or with insulin pump. So when patients fail medical therapy, the use of a pancreas transplant alone is an option for them. But that is a less common procedure than a combined transplant.
So the objective of the pancreas transplant operation is to give someone normal glucose control. They come in being a diabetic, on a restricted diet, on insulin, and after a successful pancreas transplant, they are off insulin, they return to a regular diet, so they are no longer carbohydrate-controlled or a low sugar diet, and they can eat fairly normally and have normal glucose control.
For a pancreas transplant, the organ always comes from a deceased donor.
The other situation in which we do a pancreas transplant alone, is if someone has type one diabetes and has kidney failure and has a live donor for the kidney. We could do a live donor kidney transplant operation, allow the individual to recover from that, and then come back a period of time later – often about six months later – and then do a pancreas from a deceased donor. We refer to that as a “pancreas after kidney transplant” and the advantage of that approach is you get an optimal kidney from a live donor without waiting, come off of dialysis or avoid dialysis all together and then address the diabetes issue later with the pancreas.