Pancreatic Transplant in children with T1DM !
Q) What is Pancreatic Transplant (PT) ?
A) PT is a surgical procedure which aims at restoring insulin secreting capacity of the pancreas and in so stopping the need for insulin injections (if successful). It was first done in 1966 and >80,000 have been performed worldwide.
Q) Who are the patients who have indications for PT?
A) Currently the patients who have undergone PT are based on t he following criteria :
- T1DM diagnosed by positive autoantibodies>5 Years, low C-peptide values
- Glycemic lability/variability, hypoglycemia unawareness
- Associated with significant one or more chronic diabetes complications despite compliant intensive insulin therapy
- Post pancreatectomy or chronic pancreatitis.
- Cystic fibrosis related diabetes
Q) What are the types Types of Pancreatic transplant being done ?
A) The different Types of Pancreatic transplant are:
- Whole pancreatic transplants
- Islet cell transplant
Q) What are the complications associated with PT ?
A) PT is associated with short term complications like :
graft rejection,
hepatic vein
thrombosis,
hepatic microsteatosis.
Long term complications can be due to immunosuppression and other long term medicines that’s need to be continued which considerable side effects of their own.
Q) Then why are PT not being done more in children with T1DM ?
A) The reason it is not advocated as the first line of treatment in child is
- The number of Studies in children are very limited and we do not have the data if it will be successful in children
- The pancreas needed for human has to be from brain dead/ recent deaths and the availability of this is very low!
- There are very few centres with the facilities and expertise to perform these surgeries successfully in children with T1DM
- There are high risk involved with donor recipient and graft rejection after the surgery.
A lot of research are still ongoing in the field of Pancreatic Transplant in children with T1DM, we need robust data in Pancreatic Transplant in children with safety parameters well established and long term success of the surgery being the most important factors to be able to recommend the procedure as standard treatment care for children.
