Dual Organ Transplant
Dual organ transplantation is the best treatment that helps in restoring quality of life for the patients with serious illness and multiple organ failure. Dual organ transplantation is a type of transplantation which is performed by experienced surgeons. Dual organ transplantation includes:
1. Kidney and heart dual organ transplantation
2. Kidney and liver dual organ transplantation
3. Kidney and pancreas dual organ transplantation
Dual organ transplantation is performed in patients who are suffering from serious illness and multiple organ failure patients who have another organ failure along with liver, both the organs are transplanted in the patient at the same time. Dual organ transplantation is a viable treatment, which can restore the quality of life.
One of such dual organ transplantation is kidney-pancreas transplantation this is an operation to place kidney and pancreas at the same time that have a kidney failure along with high diabetes.
Kidney and Pancreas Transplant
For patients having Type 1 diabetes who are in kidney failure, kidney and pancreas dual organ transplantation is often a best treatment option. The number of patients who get a dual organ transplant benefit from restored quality of life in many cases, the patients will be no longer needing dialysis or insulin. For patients waiting for this dual organ transplant, the pancreas allocation determines the time to transplant and this means that patients waiting for the dual pancreas/kidney transplant always will be transplanted earlier than patients waiting for a kidney alone.
Patients in need of kidney and pancreas transplantation are well advised to seek out the support of experienced doctors.
Simultaneous kidney pancreas transplant is an operation to place kidney and pancreas at the same time in a patient who has kidney failure and also suffers from diabetes, needing very high insulin dose to control sugars. It can be type 1 or burnt out type 2 diabetes. Type 1 diabetes is an autoimmune disease where patients own body attacks and destroys insulin producing beta cells located in the pancreas. It is typically seen in children and young adults. Type 2 diabetes is what we see commonly in adults. Over a period of time, these patients’ insulin producing cells stop making insulin or they are unable to produce enough to meet the body's demand.
Discovery of insulin converted lethal disease like diabetes into a chronic debilitating disease. Diabetes affects every system in the body. In the eyes it affects retina and is the leading cause of blindness. It affects the blood vessels supplying the heart and is common cause of heart attacks. It accelerates atherosclerosis which is a common cause of strokes/paralysis, heart failure and kidney failure. Uncontrolled sugars affect the nervous system also. Once the peripheral nervous system is affected, sensation in the hands and feet comes down. Continued injury is one of the leading causes of loss of limb.
Diabetic patients with kidney failure need kidney transplant to prolong their life. Steroids used as immune suppression will make treatment of diabetes difficult. Poorly controlled sugars will continue to affect the rest of the body including the transplanted kidney. Performing pancreas transplant at the same time will eliminate all these problems by optimally controlling sugars. It will not only protect the transplanted kidney form suture effects of diabetes but also reverse the effects of diabetes on other systems including peripheral neuropathy and thus protect the limbs.
Pancreas is most commonly transplanted along with kidney at the same time (SPK-simultaneous pancreas and kidney transplant). However it can be transplanted after kidney transplantation (PAK-pancreas after kidney transplant). In rare situation, especially type 1 diabetics who have developed advanced neuropathy and are unable to appreciate low glucose levels (hypoglycemia unawareness) will benefit from pancreas alone transplant(PAT), even though they don't have kidney failure. They will be on unrestricted diet, free from frequent sugar checks and insulin injections.
Heart and Kidney Transplantation
Chronic kidney disease following heart transplantation is a major source of morbidity and mortality. When patients present with extensive coexisting heart and kidney disease, the presence of severe, irreversible kidney dysfunction is a contraindication for isolated heart transplant.
Heart and kidney dual organ Transplantation has become an accepted treatment option for patients with this challenging clinical scenario. Success has been documented after simultaneous or staged Heart and kidney Transplantation. The criteria for consideration of combined organ transplant include a glomerular filtration rate less than 40 mL/min, despite hemodynamic optimization.
Survival rates for Heart and kidney Transplantation recipients were similar to those achieved after isolated heart transplantation. Similar to the observations after Heart and kidney Transplantation, the incidence of cardiac rejection was less frequent after Heart and kidney Transplantation than after isolated heart transplants.
Liver and Kidney Transplant
A liver and kidney transplant is recommended for patients with end-stage disease in both organs and seems warranted for patients with hepatorenal syndrome (a potentially reversible renal failure caused by liver disease) receiving hemodialysis (HD) for more than 2 months, according to a retrospective case series.
“Liver and kidney transplantation offers the best option for patients with simultaneous chronic liver and kidney failure, when it is performed at a high-volume academic transplant center. In patients with hepatorenal syndrome, dual organ transplantation seems to confer survival advantages in those who receive 2 months of pre transplant dialysis, and the liver is immuno protective for kidney transplants.