Pancreas Transplantation in India

Pancreas Transplantation in India

A successful pancreas transplant is the only certain cure for patients suffering from diabetes. Diabetes occurs either because of less insulin in your body or your body becoming resistant to the effects of insulin because of obesity. Insulin is required for utilization of glucose present in the blood which comes from the food we eat. Having less insulin in your body leads to increase in the levels of glucose in your blood. The vessels carrying the blood to different organs do not tolerate high blood sugars well, resulting in damage to the lining membrane of the blood vessels which further damages the organs supplied by these blood vessels. The various organs which are commonly damaged by diabetes include eye, kidney, nerves, heart etc.

Traditional Methods to Control Diabetes

Most patients with diabetes take medicines to control their blood sugar, but those with complete absence of insulin in the body require multiple daily injections. Even with medicines and insulin, it is very difficult to have an optimal control of blood sugar, and patients often have wide fluctuations in their blood sugar. Overdose of these medicines or less than usual intake of food can also result in lowering of blood sugars to dangerous levels and sometimes result in coma. Fortunately, the body has a mechanism to let a person know about hypoglycemia by means of intense hunger, sweating and increase in heartbeat. But over a period if the nerves also get damaged because of diabetes, this awareness regarding hypoglycemia is also lost, and is termed as hypoglycemic unawareness. These patients can easily slip into coma.

Apart from insulin and drugs, many other approaches have been tried to cure diabetes. One of these includes delivery of insulin by a pump with a glucose sensor attached to it. This pump is attached to the patients’ tummy which continuously releases insulin in the body depending upon the blood glucose levels. However, pumps limit an individual’s activities and a malfunction of pump or its sensor can result in dangerous increase or reduction in blood sugar.

Doctors have also tried injection of stem cells into pancreas or liver but long-term outcomes after these have been disappointing.

The Solution

Only two approaches have been proven to be effective in curing diabetes. The first one is injection of insulin producing cells, and the other is pancreas transplantation. Both these approaches require a human pancreas which is obtained from an organ donor after her/his death. While a few pancreas transplantations have been reported after obtaining an organ from a living donor, the procedure is considered risky for the donor and is not widely practised. As both these approaches also require the donor organ from some other individuals, a transplant patient must be given medicines to suppress their immune system.

Pancreas transplantation requires a major surgery with associated risk of complications, whereas injection of insulin producing cells is much easier. However, diabetes frequently recurs in a few years after injection of these cells and long-term results again are much inferior as compared to pancreas transplantation.

Retrieved Pancreas

Retrieved Pancreas

A successful pancreas transplant restores the insulin supply to the body and causes normalization of blood glucose. The complete normalization of blood glucose also can reverse some of the complications of the disease. The most common pancreas transplantation is a simultaneous pancreas-kidney transplantation where patients suffering from kidney failure due to diabetes are transplanted with both organs. (In an ideal situation, patients should be offered transplantation before the development of kidney failure.

Transplanted Pancreas

Transplanted Pancreas

India & Pancreas Transplants

The first such successful transplants in the world were performed in the 1970’s and about 1000 pancreas transplants are performed in the USA each year. In contrast to this, less than 100 such transplants have been performed in India.

The reasons for lack of pancreas transplantation in our country has been the lack of availability of organ donors, as very few persons chose to donate their organs after death. But situation is changing very fast and over 900 persons donated their organs last year in the country.

However even this increase in number of organ donors in India is very low as far as pancreas transplants are concerned. This is because unlike kidney and liver, only a small proportion of all donated pancreas’ can used for transplantation, as criteria for pancreas suitability for transplantation are very strict – like age limit of between 10-45 years, lack of obesity etc. If an unsuitable pancreas has been used for transplantation, the recipients’ recovery after transplantation is delayed and complications are much higher. Therefore, only an ideal pancreas can to be used for transplantation, and this limits the amount of pancreas transplants in India.

Another reason for low numbers of pancreas transplantation in our country is presence of very few trained transplant surgeons in the country. While there are ample surgeons across different specialties who perform liver and kidney transplantation, pancreas transplantation requires special training. At present, only a few centers across the country with trained surgeons offer pancreas transplant on a regular basis. Those centers are PGI Chandigarh, IKD, Ahmedabad, and Apollo Hospital, Chennai.

At PGI Chandigarh, pancreas transplantation was initiated in December 2014, and 16 such transplants have been performed so far. Nearly all these operations have been performed in diabetic patients with end stage kidney disease. The total cost of an uncomplicated operation has been between 4-5 lakh at PGI but will vary depending on which hospital a patient goes to.

Outcomes

While the outcomes were mixed after the early few operations, the recent cases have been completely successful with patients coming off both dialysis and insulin. The majority of patients transplanted were young and were on 4-5 daily injections of insulin for many years.  One of them had been on insulin injections since the age of 2! While the successful kidney transplantation has given them freedom from twice a week dialysis, pancreas transplantation has allowed them to eat whatever they like without any fear of complications of diabetes. Moreover, the patients relish the freedom from 8-10 daily needle pricks required for monitoring of their blood sugar and administration of insulin injections.

The boy in red is a pancreas & kidney transplant patient at the annual athletic meet of transplant patients

The boy in red is a pancreas & kidney transplant patient at the annual athletic meet of transplant patients

It is hoped that with increasing awareness regarding organ donation, more pancreas would be available for transplantation and number of such transplants would increase the benefit to thousands of diabetic patients in the future.

Dr. Ashish Sharma

Dr Ashish Sharma is Professor and Head Institution Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh and has contributed more than 50 publications in reputed national and international journals. He started laparoscopic donor nephrectomy at the Institute and has trained budding transplant surgeons from different parts of India in this technique. His active involvement in promoting deceased donor transplantation at PGIMER and improving protocols for identification and counselling of brainstem dead donors has led to an increase in deceased organ donations from 1-2 per year to 26 in 2015. He also initiated simultaneous kidney pancreas transplantation at PGI Chandigarh in 2014 and nine such transplants have been performed so far. He formed a protocol to successfully perform Donation after Cardiac Death for the first time in India in 2014 which has led to 15 kidney transplants from such donors.

17 Comments

  1. Prof[Dr.Vatsala Trivedi · October 13, 2018 Reply

    Excellent dear Ashish

  2. S A RAHMAN · February 10, 2019 Reply

    Felt very happy after going through this article. Actually my daughter is 8 years old and she is diagnosed with type-1 diabetics. Can I transplant my pancreas to her. If so what is the procedure? whom I need to contact? What is the approximate cost. I want to know in detail. Please provide me with contact information so that I can reach them. Please.

  3. Ashish Sharma · February 10, 2019 Reply

    Pancreas transplant is currently being offered to patients with end stage kidney disease due to diabetes. After transplant, you still have to take medications which have their side effects. Therefore you are better off with managing Diabetes with insulin till you have some serious complications like kidney failure. If you manage your diabetes well, most of the complications can be delayed for many years.
    Pancreas transplant from a living donor is not being done in India at present and is performed only at a few centres across the world as there is an inherent risk to the donor developing diabetes

  4. Akanksha · February 26, 2019 Reply

    Hi Dr Ashish sir plz help me my sister is suffering from cronic kidney disease so you can help me for transplant Donor… Plz sir help me and my blessing with you always as a sister.
    From. Akanksha
    Plz reply me in email is
    akanksha2728912@gmail.com

  5. Gaurav Sharma · July 2, 2019 Reply

    Pls send me full details for pencrias transplant cost prosidure and rembursment for mediclaim religare ncb super

  6. SOUMYAJIT CHOUDHURY · August 7, 2019 Reply

    Dear Dr. Ashish, My spouse is 45 years old having chronic pancreatitis. Stenting have been done 3 times in her bile duct to remove the blockage. Is Pancreas Transplant possible to cure the problem permanently? We have a little child and he misses his mother due to hospitalization while she suffers from severe pain. Please send your valuable guidelines at EFLSOUMYA@GMAIL.COM.

    Soumyajit Choudhury
    eflsoumya@gmail.com

  7. Ashish Sharma · August 8, 2019 Reply

    She would require removal of her pancreas to relieve the recurring episodes of pain. In most patients, it is not worth doing it as there are even more problems after removing the pancreas. Pancreas transplant is required only for those rare patients who have undergone removal of pancreas and suffer from diabetes and poor digestion. The treatment of choice for chronic pancreatitis would be removal of pancreas and islet cell autotransplantation to take care of diabetes but islet cell transplantation is currently not available in our country

  8. SOUMYAJIT CHOUDHURY · August 8, 2019 Reply

    Thank you very much Dr. Sharma. I have heard of Artificial Pancreas transplantation a few days back. Can you please clear the same?

    Soumyajit Choudhury
    eflsoumya@gmail.com

  9. Sharan · September 20, 2019 Reply

    Hii Dr. Ashish sir my brother is suffering from diabetes type 1 from 20 years and in 2015 he got kidney transplant at Dmc hospital Ludhiana I have only one brother he is 27 years old I want know about pancreas transplant can u plz help me for that sharanjeetkaur754@gmail.com it’s my email ID plz send me all process of pancreas transplant

  10. Hardik · October 5, 2019 Reply

    I’m 23 year old.i’m type 1 diabetes patient suffering from 1 year.i want to pancreas transplant.what is the approximate cost.plz give me answer whom I need contact..
    hardikparmar819642@gmail.com it’s my email id …Plz give me your ans

  11. Bibin · November 21, 2019 Reply

    Got diabetic am 28 can possible to do pancreas transplant successfully how long take recover after operation plz explain sir

  12. laisha · January 27, 2020 Reply

    Dear Dr Ashish,

    I am 34 years old and have been diagnosed as a type 1 diabetic recently. Until now I was diagnosed as a type 2 .. and was on a high dose of glycomet. Since 2 years I have developed renal failure with a creatinine of 2.5 and rising .. Also I am loosing my vision slowly and steadily to diabetic retinopathy.

    Can I be a candidate for both kidney and pancreatic transplant. If yes where should I start.

  13. Simran · February 19, 2020 Reply

    Hi is this kind of transplantation is sucessfull in patients suffring from chronic calcified pancreatitis

  14. Hemant Goswami · March 15, 2020 Reply

    Hi doctor Ashish,

    My 7 year old nephew recently got diagnosed with type 1 diabetes and we are giving 3 time insulin per day.

    Now we are planning to come PGI chandigarh for pancreas transplant.please suggest/reply on 9718399987/hemantgoswami2025@gmail.com it’s very very urgent

  15. Sunny · April 12, 2020 Reply

    Sir I m 35 yrs old.I am type diabetic since last 14yrs.I take insulin 4 times a day.I have poor control on sugar level and I have started developing secondary infections like fungal,gastritis,itching and high creatine value and my stomach is growing inappropriately.

    Pls help me ans will pancreatic transplants solution.

  16. Venkatesh sindhe · April 14, 2020 Reply

    Sir myself venkatesh please send me the correct address to consult you now I am 28 can I get lslet transplantation with diabetes mellitus types 1 h1bc and how longer we have to suffer

  17. SAHIL WADHWA · December 11, 2020 Reply

    I am 32 years old suffering from diabetes since last 17 years and taking insulin since then..
    Now reached on end stage of kidney disease having creatinine 7.19
    Thyroid and BP also associated with it.
    I went to PGI chandigarh on 04.12.2020 and on consultation with Doctor, I registered for SPK transplant but having blood group O+ I think my chances of getting my turn as per list registered for SPK is very less.
    Can u gave some suggestion on this as I am not in position to wait anymore as per my helth condition for transplant.

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