Our Summary

This research paper discusses how the success of pancreas transplants has improved due to better surgical techniques, careful choice of donors, and improved methods of suppressing the immune system to prevent rejection of the transplant. However, the long-term success of these transplants can still be negatively affected by the body’s rejection of the transplant and the toxicity of the drugs used to suppress the immune system.

The paper focuses on a particular group of immune system-suppressing drugs, known as mammalian target of rapamycin inhibitors (mTORi). These drugs can interact with other medications and this is discussed in the paper. The paper also looks at the damaging effects these drugs can have on the kidneys and their potential to cause diabetes after a pancreas transplant. The authors discuss ways to minimize these negative effects and mention other possible side effects.

The paper asserts that the main type of treatment after a combined pancreas-kidney transplant is still a regimen based on calcineurin inhibitors (CNIs). However, long-term use of these drugs can harm the kidneys. Switching from CNIs to mTORi (specifically, drugs called sirolimus and everolimus) may help to protect the kidneys, but these drugs can cause an imbalance in the body’s mTOR signaling system over time, which could lead to protein in the urine and high blood sugar levels.

These drugs can also interfere with the body’s natural process of recycling waste materials (autophagy), inhibit cell growth, and reduce the level of a protein called VEGF. Therefore, it’s important to fully understand and interpret the data from experiments and to critically analyze clinical studies. The paper emphasizes that reducing side effects as much as possible can help to prolong the life of the transplanted kidney. However, more research is needed to assess the impact of mTORi on the survival of transplanted pancreas.

FAQs

  1. What factors have contributed to improved patient and pancreas allograft survival rates?
  2. What are the potential side effects of long-term use of mTOR inhibitors (mTORi) following a pancreas transplant?
  3. Are there any alternative treatments to mTORi that can minimize the potential negative effects on the kidney after a pancreas-kidney transplant?

Doctor’s Tip

A doctor might tell a patient undergoing a pancreas transplant to carefully follow their prescribed immunosuppressive regimen to prevent rejection of the transplant. They may also advise the patient to be aware of potential drug interactions and side effects, such as nephrotoxicity and hyperglycemia, associated with medications like mTOR inhibitors. Regular monitoring and communication with healthcare providers are essential for long-term success of the transplant.

Suitable For

Patients who are typically recommended for pancreas transplant are those with type 1 diabetes who have severe complications from the disease, such as kidney failure or severe hypoglycemia unawareness. Pancreas transplant may also be considered for patients with type 2 diabetes who have not responded well to other treatments and have complications from the disease. Patients who are recommended for pancreas transplant should also be in good overall health and able to tolerate the surgery and lifelong immunosuppressive medications.

Timeline

  • Pre-transplant: The patient undergoes evaluation to determine their suitability for a pancreas transplant, including medical history, physical exams, and various tests such as blood tests and imaging studies. Once deemed eligible, the patient is placed on the transplant waiting list.

  • Day of transplant: The patient undergoes surgery to receive a pancreas transplant, either alone or in combination with a kidney transplant. The surgery typically lasts several hours.

  • Post-transplant: The patient is closely monitored in the hospital for complications such as rejection, infection, and surgical complications. They will also start taking immunosuppressive medications to prevent rejection of the new pancreas.

  • Weeks to months post-transplant: The patient continues to be monitored closely for any signs of rejection or complications. They will have regular follow-up appointments with their transplant team and may need adjustments to their medication regimen.

  • Long-term post-transplant: The patient will continue to take immunosuppressive medications for the rest of their life to prevent rejection of the pancreas. They will also need to follow a strict diet and exercise regimen to maintain their overall health. Regular follow-up appointments will be necessary to monitor the health of the pancreas allograft and address any issues that may arise.

What to Ask Your Doctor

  1. What is the success rate of pancreas transplants in your patients?
  2. What are the potential risks and complications associated with a pancreas transplant?
  3. How will the immunosuppressive medications affect my overall health and well-being?
  4. What is the long-term outlook for a pancreas transplant recipient?
  5. Are there any specific dietary or lifestyle changes I should make post-transplant?
  6. How often will I need to follow up with you after the transplant surgery?
  7. What signs or symptoms should I watch out for that may indicate rejection or other complications?
  8. Are there any alternative treatments or medications that could be considered instead of a pancreas transplant?
  9. How will the transplant impact my existing medical conditions or medications?
  10. Are there any clinical trials or new treatment options that I should be aware of for pancreas transplants?

Reference

Authors: Fernandes-Silva G, Ivani de Paula M, Rangel ÉB. Journal: Expert Opin Drug Metab Toxicol. 2017 Apr;13(4):367-385. doi: 10.1080/17425255.2017.1239708. Epub 2016 Sep 28. PMID: 27659512