Reader in Transplant Surgery at the University of Edinburgh
Honorary Consultant Transplant Surgeon at the Royal Infirmary of Edinburgh
Pancreas and islet transplantation
Ms. Lorna Marson
Lorna Marson
Pancreas transplants we have been undertaking here, I would say, since the early 2000s. And they are much smaller in number – we undertake about 25 kidney and pancreas transplants that are usually combined here in Scotland…
With a Scottish programme for kidney-pancreas transplants, as opposed to 100 kidney transplants a year that we perform here.
I think there are several aspects behind why pancreas transplant was developed later. One is that, clearly, patients with diabetes mellitus, for whom that would be the indication for a pancreas transplant, have an effective treatment in the form of insulin injections, and well-controlled diabetics on insulin manage very well over a long period of time. So it is relatively recently that the potential benefits of a pancreas transplant over and above insulin injections have been realised. Technically it is a much more technically challenging operation than a kidney only. As medical students and junior surgical trainees we’re always taught never touch the pancreas, leave it alone. And there are good reasons for that. It’s a difficult organ to handle, it’s very friable, and so technically it makes transplanting such an organ more challenging.
Of course the other really interesting area is that we can now transplant islets. Islet cells can be isolated from whole pancreata, and injected into a patient, so that they don’t have to undergo the major operation that is a pancreas transplant – but that is for a very defined group of patients currently. The islets of Langerhans are an area within the pancreas that produce the cells – sorry – that contain the cells that produce insulin, that are lacking or failing in patients with diabetes.
With a Scottish programme for kidney-pancreas transplants, as opposed to 100 kidney transplants a year that we perform here.
I think there are several aspects behind why pancreas transplant was developed later. One is that, clearly, patients with diabetes mellitus, for whom that would be the indication for a pancreas transplant, have an effective treatment in the form of insulin injections, and well-controlled diabetics on insulin manage very well over a long period of time. So it is relatively recently that the potential benefits of a pancreas transplant over and above insulin injections have been realised. Technically it is a much more technically challenging operation than a kidney only. As medical students and junior surgical trainees we’re always taught never touch the pancreas, leave it alone. And there are good reasons for that. It’s a difficult organ to handle, it’s very friable, and so technically it makes transplanting such an organ more challenging.
Of course the other really interesting area is that we can now transplant islets. Islet cells can be isolated from whole pancreata, and injected into a patient, so that they don’t have to undergo the major operation that is a pancreas transplant – but that is for a very defined group of patients currently. The islets of Langerhans are an area within the pancreas that produce the cells – sorry – that contain the cells that produce insulin, that are lacking or failing in patients with diabetes.