The pancreas is a pear-shaped organ situated deep in the abdomen. It is a critical controller of blood sugar levels. Part of the pancreas is sandwiched between the stomach and the spine and the other part is snuggled in the curve of the duodenum (which is the first part of the small intestine).
The pancreas is made up of two functional components. It is really two glands that are mixed together into one organ. For the most part the pancreas is composed of “exocrine” cells or Acinar cells. The second functional component of the pancreas is the “endocrine” cells.
Acinar cells produce and transport enzymes that are passed into the duodenum where they help in digesting food. The endocrine cells of the pancreas produce and secrete hormones such as insulin and glucagon into the bloodstream which work together to maintain the proper levels of sugar (glucose) in the blood.
There are a variety of disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer.
The inaccessibility of the pancreas makes evaluation of pancreatic diseases difficult. Various methods such as a physical examination, blood tests, CAT scan, endoscopic ultrasound, and MRI can be used, the last three being more accurate. Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP (magnetic resonance cholangiopancreatography). Sometimes surgical exploration is the only way to confirm a patient’s diagnosis.
Acute pancreatitis is an abrupt attack causing inflammation of the pancreas. This will in most cases result in severe upper abdominal pain. The pain may be severe and last several days. Other symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, and fever. Gallstones are the most common cause of this kind of pancreatitis. Other causes include chronic alcohol consumption, hereditary conditions, trauma, medications, infections, electrolyte abnormalities, high lipid levels, hormonal abnormalities, or other unknown causes. The treatment is usually supportive with medications showing no benefit. Most patients with acute pancreatitis recover completely.
Chronic pancreatitis is the progressive disorder associated with the destruction of the pancreas. It is more common seen in men and develops in persons between 30 and 40 years of age. Chronic pancreatitis may be confused with acute pancreatitis because the symptoms are similar – upper abdominal pain and diarrhea. Acute recurrent attacks of pancreatitis early in life can also progress to chronic pancreatitis.
As the disease becomes more chronic, patients can develop malnutrition and weight loss. If the pancreas is devastated in the latter stages of the disease, patients may develop diabetes mellitus.
The most common cause of chronic pancreatitis is chronic alcohol consumption. Other causes are cystic fibrosis and other hereditary disorders of the pancreas. For most patients there is no known cause.
The treatment for chronic pancreatitis depends on the symptoms. Therapies focus on pain management, nutritional support, and oral pancreatic enzyme supplements to aid in the digestion of food. Patients who develop diabetes require insulin to control blood sugar. Alcohol must be abstained from under all circumstances.
In some cases, pancreatitis is linked to inherited abnormalities of the pancreas, most commonly cystic fibrosis. Genetic testing can be a useful in detecting patients susceptible to hereditary pancreatitis.
Like chronic pancreatitis, hereditary pancreatitis is a progressive disease that can likely cause permanent problems. Patients could experience chronic pain, diarrhea, malnutrition, or diabetes. Treatment focuses on pain control and pancreatic enzyme replacement.
Pancreatic cancers are mostly formed in exocrine cells. These tumors are hard to diagnose early as they do not present signs and symptoms early and there is no secretion of hormones that can be detected. Current treatments of radiation and chemotherapy do not cure the exocrine pancreatic cancer for most patients. Certain malignant pancreatic neuroendocrine tumors, such as islet cell tumors, have a better outcome than pancreatic exocrine cancers.
In India, the death rate is 1.18 of 10 in case of pancreatic cancer and the treatment depends on the location and stage of the cancer. Overall health and personal preferences of the patients also play a role in the treatment outcome. Surgically, the pancreatic tumors can be removed in the pancreatic head, tail and body. High-energy beams, such as X-rays, are used to destroy the cancerous cells under radiation therapy. In chemotherapy, drugs are used to help kill cancer cells.
Pancreatic cancer is resistant to many standard treatments such as chemotherapy and radiation therapy. It does not cause symptoms initially and grows insidiously. Painless jaundice, a yellowish skin discoloration with no other symptoms is the classic presentation of pancreatic cancer. Different radiographic imaging techniques are usually used to make diagnosis.
Pancreatic cancer can be cured by surgical resection if detected in the early stages but this is not the case usually as it is detected only later. At later stages, the quality of life can be improved by controlling symptoms and complications as a part of the treatment.
Pancreas transplantation is mainly performed for patients with end stage kidney failure due to Type I diabetes. These patients undergo combined kidney and pancreas transplantation, which takes care of the kidney failure as well the disease which caused the kidneys to fail. There are other patients with Type I diabetes who have a lot of fluctuation in their blood sugar levels resulting in life threatening hypoglycemia. Pancreas transplantation alone can be a life-saving procedure for these patients as well.
Some patients with Type II diabetics, with end stage renal disease and without significant insulin resistance can also benefit from the combined pancreas kidney transplant. Despite advances in insulin administration, only pancreas transplantation achieves perfect glycemic control and can stop the progression of vascular complications because of diabetes. It can also reverse peripheral neuropathy and diabetic retinopathy, prevent recurrence of diabetic nephropathy in the transplanted kidney and improve patients’ quality of life as they are no longer dependent of multiple injections or sugar monitoring. It also makes them free to eat whatever they like.
The patient for pancreas transplantation has usually involvement of multiple organs including eyes, heart and nerves. Therefore, patient should have a detailed cardiac, neurologic and vascular evaluation apart from the regular evaluation for a kidney transplant patient. Patients would undergo Echocardiography, ECG and Stress thallium to evaluate the cardiac condition. Any abnormality in these would require coronary angiography. Doppler or CT scan of abdominal vessels may be required if there is evidence of vascular disease. C-peptide and blood insulin levels are done to confirm absence of insulin. Glycated hemoglobin is measured to know the overall control of blood sugars. Other routine investigations like blood counts, liver function tests, chest X ray are also performed.
Registration is done after completion of all preoperative investigations. There is a waiting period ranging from 1-2 years depending on the blood group. The patients are listed in a separate list for combined pancreas kidney transplant and usually get priority for kidney allocation once pancreas donor is identified.
The biggest change following the pancreas transplant is stability of blood sugar levels. It becomes no longer necessary to regularly measure blood sugar or to plan meals and activities. The constant fear of unpredictable blood sugar levels, the risk of hypoglycaemia and loss of consciousness too are overcome. Patients are able to choose food and activities according to their own wishes and can participate in all physical activities as well giving greater autonomy and more stability in their daily lives
However as with all transplants, patients need to take immunosuppression medications for the rest of their life to help prevent transplant rejection and get lab testing done on regular basis. They also have to be careful to avoid infections
Currently less than 100 pancreas transplants have been performed across the whole country but the numbers have picked up in the recent years. The main hospitals providing pancreas transplant in India are PGI in Chandigarh, Apollo Hospitals in Chennai and Institute of Kidney Diseases in Ahmedabad. If someone wants to register for pancreas transplant, one can visit our transplant guide for details of the hospitals doing pancreas transplant or call on our toll free helpline number 1800-120-3648.