Battling blood sugar since she was 5, Chandigarh teacher doesn’t need insulin or drugs anymore: How a dual pancreas-kidney transplant gave her new life

She was referred to the Post-Graduate Institute of Medical Education and Research (PGIMER-Chandigarh), the country’s leading pancreas transplant centre. “I had gone there for a kidney transplant but the doctors informed me that I was a perfect candidate for a double kidney-pancreas transplant. That was the first time I hoped to live pain-free, without my shots,” she says.

Why kidney-pancreas dual transplant is necessary

A simultaneous kidney and pancreas transplant is necessary for people like Isha with Type 1 diabetes and end-stage kidney disease as it corrects both conditions at once. The patient’s damaged kidney is replaced, while the transplanted pancreas produces insulin, effectively curing the diabetes and preventing the disease from damaging the new kidney. “If only a kidney is transplanted without a pancreas, the diabetes can recur and damage the transplanted organ,” says Dr Ashish Sharma, transplant surgeon, PGIMER-Chandigarh.

It may also be performed in patients with severe complications from the more common Type 2 diabetes. An estimated 2.5 lakh people live with Type 1 diabetes in India, with the prevalence of Type 2 being a much higher 10.1 crore.

What are challenges for the procedure?

While kidney transplants have become commonplace in India, pancreas transplant is still in the nascent stage. However, PGIMER Chandigarh has taken the lead in the country, performing 64 transplants over the last 10 years. In fact, Chandigarh had the highest number of pancreas transplants in the country last year, with 30 of the country’s 44 transplants being conducted there, according to data from the country’s apex regulator National Organ and Tissue Transplant Organisation.

“It is a tragedy that in a country like India, with such a high burden of diabetes, a handful of pancreas transplants are taking place. There are around 1,000 deceased persons whose families agree to donate their organs, yet only 30 to 40 transplants take place. Only a small proportion, say around 20 per cent of the donated pancreas, are fit for transplantation. With 1,000 donations, there should still be around 200 pancreas transplants taking place every year in the country,” says Dr Sharma.

Importantly, both kidney and pancreas have to be transplanted together in these patients, presenting another challenge. “The patients have to be allocated both kidneys and pancreas together, which is not a criteria followed in many states, except Punjab and Haryana, and, of course, Chandigarh (Union Territory). The patients also need to be rostered on a priority basis in the waiting list. Patients need to undergo the transplant within three years of starting dialysis for the best outcomes, another criteria followed by Chandigarh for allocation of organs, allowing us to take a lead when it comes to pancreas transplants,” says Dr Sharma.

The three-year wait

As Isha was put on the transplant list for both kidney and pancreas, she started her dialysis. For nearly three years, she got dialysis done two to three times a week. She also had to continue her insulin jabs to keep her blood glucose levels in control. “Although I did not have any complications, it was still difficult to manage, measuring life in between various sessions and routines. Then one fine day, I received a call from PGI saying that I might be getting both the organs,” said Isha.

She was still wary when she went to the hospital, wondering whether the organs would be a match. They did after a thorough check of blood type compatibility, antigens and antibodies. The donor tissues seemed safe. Isha underwent the kidney and pancreas transplant in January 2020. Soon after, the pandemic hit.

The recovery, rehabilitation and a renewed life

The new pancreas starts working within an hour and the new kidney within a week. A dual kidney and pancreas transplant requires intensive monitoring in the hospital for one to two weeks after surgery, including intensive care unit (ICU) care, to watch for complications and infection. Recovery involves taking life-long immunosuppressive medications to prevent organ rejection, early physical mobilisation to prevent blood clots and a diet that encourages bowel function.

“I was completely restricted to my home because I could not afford to contract Covid. The only time I stepped out was to go to the hospital for my regular check-ups. And, even then, I would plan everything with my doctor to maintain hygiene and compliance of rules,” says Isha, who was able to avoid the infection.

Normalcy is a gift

Five years later, Isha does not have to take any insulin shots. Neither is she on any oral medication to manage her blood glucose levels. In fact, her blood glucose levels have been stable and normal since the surgery. “I do not need to get dialysis or take any medicine for my kidney either. The only medicines I take are immunosuppressants,” she says.

As Dr Sharma explains, “Most patients — nearly 80 per cent of those who undergo a pancreas transplant — are able to get off insulin and any other medicine to control blood glucose levels. Another 10 per cent may continue to need some medications, but the fluctuations in their blood glucose levels are no longer as severe as the ones seen in Type 1 diabetics, who need to be hospitalised sometimes because of the blood glucose level plummeting sharply.”

Isha now feels happiest with her primary class students, reclaiming bits of her childhood and catching up with life.