Beyond Medication – Transplants and Dialysis

A consequence or complication of inadequately controlled blood sugar may be that permanent damage occurs to various vital organs. Whether it is the result of undiagnosed or neglected type 1 diabetes (T1D) or type 2 diabetes (T2D), the damage may progress until an organ stops functioning. For example, damage from diabetes may impair the proper functioning of your kidneys and pancreas leading to a host of new medical problems. As a result, you may be faced with the decision to undergo radical treatments or dialysis. In the most extreme cases, it may be necessary to consider a transplant.

The Kidney and Dialysis

Health problems, such as kidney disease may go undetected for some time. Some of the early symptoms may be mild. Unfortunately, left unchecked the situation will get worse and eventually symptoms like chronic fatigue and leg swelling begin to drive people to the doctor. At this point the problem may have gone too far to be repaired. A doctor may note high blood pressure. The lab will probably report a high urine creatinine. The latter in particular indicates that your body is suffering from severe renal (kidney) damage. At this point, there is no turning back because the kidneys can no longer to their job. They will no longer be able to efficiently and effectively clear the body of waste. The end result will inevitably be a need for dialysis.[1]

Hemodialysis is a mechanical way of doing the work of your kidneys. It is a procedure in which the normal waste, water or excess salt in your body are filtered out using a machine. The process involves filtering the blood. The overall procedure is both tiring and time consuming as it must be repeated every few days. Moreover, there is a high incident rate of infection.

Peritoneal dialysis also filters the blood but inside the body. A catheter is placed in the abdomen and the abdominal (peritoneal) cavity is filled with a solution of dialysate. The solution pulls the waste and water out of the blood and uses the peritoneal lining as the filtering system. There are a couple of ways this type of dialysis is accomplished with one using a machine and one only using a drainage process. The good news for some diabetics eligible for this type of dialysis is that they can be done at home whereas Hemodialysis requires a visit to a hospital or dialysis clinic.

A common reason people end up on dialysis is that they failed to manage their diabetes. It could be the result of failure to detect diabetes, but it could also be a refusal to manage the disease so the disease progresses. Yet, dialysis is not the sole answer to kidney disease and renal failure. When dialysis is out of the question, the doctor may consider a kidney or renal transplant.

Renal Transplant

When it comes to options, it is preferable to restore renal function rather than undergo dialysis. A transplant may be the logical answer in that circumstance. A transplant involves the use of a kidney from either a recently deceased individual or a live organ donor. Once the kidney has been found and the surgery arranged, the transplant occurs.

Yet, after a transplant, you cannot expect to continue as if everything was returned to normal. When a new kidney is transplanted, the situation has to be closely monitored. There is a real chance that one of the following may occur:

  • Failure of the graft immediately following the operation
  • Organ rejection that occurs over a gradual period of time

Furthermore, you will now be required to take immunosuppressive, anti-rejection medications for the rest of your life. This, too, comes with possible consequences – the complications associated with taking the drugs. Yet, overall, many diabetic patients actually fare well after a transplant.[2]

Pancreas Transplant

The number of pancreatic transplants has been documented for the years between 1966 and 2008. In this time period approximately 22,000 were performed in the United States.[3] Those individuals who are scheduled for a kidney transplant may also be able to undergo a pancreas transplant.[4] Transplants are considered for patients who fall into the following categories:

  • Has severe diabetes
  • Has as suffered from destruction of the cells of Islets of Langerhans
  • Is currently experiencing life-threatening hypoglycemia

A transplant is often approved if the patient has several of these problems as well as hypoglycemic unawareness.

A pancreatic transplant may be performed as an isolated procedure if the kidneys are normal. A pancreatic transplant may also be undertaken either in conjunction with a kidney transplant (the procedure is called a SPK) or following a kidney transplant – PAK. It is often performed in the case of end stage renal disease.[5] Approximately 90% of all pancreatic transplants do combine kidney and pancreas procedures.

The source of the transplant material is generally a deceased individual. There are, however, instances and procedures where the combined pancreas and kidney grafts come from a living donor. The pancreas is never removed. Since it serves purposes other than the production of insulin, in all likelihood it is still performing these other tasks normally.

Overall, the survival rate of grafts in the pancreas is greater than 90%. Yet, there are some issues that need to be monitored. In order to insure that the pancreas and kidney grafts escape the issue of immune-suppression, there is a need for medication. This is a lifelong responsibility as you cannot stop taking the medication or complications will occur.

Islet Cell Transplantation

Islet cell transplantation is, in theory, a very appealing procedure. It is more attractive and practical sounding than either a kidney or pancreas transplant. However, the process is still in the trial and experimental stage. As is the case with both kidney and pancreatic transplants, grafting is required. Organ donor cells serve as the source of the new islet cells.

The procedure only requires local anesthetic. The islet cells are simply injected into the liver using imaging control. As is the case in other grafting procedures, you will require immunosuppression medications.

This method of treatment does, like the whole pancreas transplantation, restore the secretion of insulin. It is not yet accepted as standard practice and remains experimental as there are still substantial problems with the procedure. An estimated 60% of pancreatic islet tissue undergoes apoptosis (cell death) a short time following transplantation.[6]

Conclusion

When your body has progressed to a stage where kidney disease occurs and renal failure follows, there are two options until new treatments are developed. You can go on dialysis or you can undergo a transplant operation.  Both options give you a chance at extending your life, as long as you follow the doctor’s orders concerning medications and health related lifestyle changes.

New procedures and improvements are currently being proposed. The islet transplant shows promise but requires more research.  It is hoped that in time people with failed kidneys or pancreas will be able to regain control over their blood sugar count with the help of a simple operation.

References

[1] American Diabetes Association (2009). Type 2 Diabetes. Your Healthy Living Guide. Alexandria, VA: ADA.

[2] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books.

[3] Gruessner, AC; and Sutherland, DER (2010). “Pancreas-transplants Outcomes for the United States (US) Cases as Reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR).” In Pancreas, Islet And Stem Cell Transplantation For Diabetes. Hakim, NS; Stratta, RJ; Gray, D; Friend, G; and Coleman, A. (ed). Oxford: Oxford University Press.

[4] Warshaw, HS; and Pape, J (2009). Real-Life Guide To Diabetes. Alexandria, VA: ADA.

[5] Pugliese, A; Reijonen, HK; Nepom, J; and Burke, GW (2011). “Recurrence of Autoimmunity in Pancreas Transplant Patients: Research Update.” Diabetes Management, 1(2):229-238.

[6] Amoli, MA; and Larijani, B (2006). “Would Blockage of Cytokines Improve the Outcome of Pancreatic Islet Transplantation?” Medical Hypotheses, 66 (4): 816-819.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.