To start with, a diabetic patient with kidney damage receives a new pancreas and a new kidney. In return, the patient is cured of his or her diabetes.
It sounds like a good exchange – and it is.
Since, in 2015, surgeons transplanted a pancreas at Rigshospitalet for the first time in 21 years, 18 patients have undergone a combined pancreas and kidney transplant – and with great success.
"All 18 patients were discharged with a functioning pancreas and, as a very positive side effect, their diabetes had disappeared with the old pancreas. One patient has since died of non-related causes, the rest are alive and in the best of health," said Allan Rasmussen, a consultant at the Department of Surgical Gastroenterology.
The new organs boost the patient's production of insulin, and this means that their diabetes disappears.
When a possible donor is found, a team from Rigshospitalet goes out, removes the organs from the donor, and then brings them back to Rigshospitalet in Copenhagen to perform the transplant.
"This is a technically complicated operation. The pancreas is the size of a banana and is hidden behind the abdominal cavity. It has a complicated blood supply that involves two of the major artery systems in the stomach, and the actual gland is not a robust organ like the liver, which can tolerate light pulling. It's best to avoid touching the pancreas because it can easily become infected, and this can be very serious, especially if it's been recently transplanted," said Allan Rasmussen.
There is also a time element: Removal and transplant must be completed within ten hours, and preferably within six.
15-20 operations a year
Rigshospitalet is the only place in Denmark where patients can have a new pancreas. Over time, Allan Rasmussen expects 15-20 transplants to be performed annually.
"In order to be considered for a transplant, a patient's diabetes must have damaged the kidneys to such an extent that the patient is at risk of kidney failure and therefore needs dialysis. So the typical patient is often at least 30 years old, but not older than 55 years. The transplant is a major procedure, and the balance between risks and benefits tips over in the mid-50s," said Allan Rasmussen.
On the other hand, the probability of success is much higher than previously.
"We've gained experience from other types of transplant, we’ve got better medicine, and we've become better at spotting when it's opportune to perform this transplant. We can reduce the damage that the immune system is trying cause to the new organ without damaging other vital functions. We simply know more," said Allan Rasmussen about the good results.
Works right away
According to the surgeon, inserting the pancreas into the patient is "relatively easy".
"It's actually not that difficult to insert. An artery is sown into the pancreas, and the vein leading the blood out again is stitched to the groin. It doesn't take much more than a couple of hours," said Allan Rasmussen.
Function can be measured almost immediately.
"We'll have an indication of whether the blood flow is as it should be as soon as we've inserted the pancreas. And if this is the case, it doesn't take long before the new pancreas takes over. Very quickly, we can establish that for the first time in many years a patient’s blood sugar has normalised. We already know that it is working before we stitch up the patient. In fact, in all 18 patients we've ascertained insulin production before the patient has left the operating theatre," said Allan Rasmussen.
This means that the patient has been cured of his or her diabetes.
"Not all the damage disappears. However, diet is suddenly not a problem, patients no longer have to worry about additional secondary damage, for example in the eyes, which is very common in diabetics, so this is a major improvement in the quality of life of a person who has been chronically ill for many years," said Allan Rasmussen.