Singapore — With the approval by the Ministry of Health (Singapore) for the pancreas transplantation service as a national programme in April 2021, Singapore’s National University Hospital (NUH) and Singapore General Hospital (SGH) will continue to collaborate and bring together best practices to further enhance patient care and outcomes in deceased donor pancreas transplantations. With this programme, Singapore will be the only Southeast Asian country with a pancreas transplant service. The programme is intended for Singaporeans and permanent residents.
The Director of the National Pancreas Transplant Programme (NPTP) is A/Prof Tiong Ho Yee, who is a Senior Consultant in the Adult Kidney & Pancreas Transplantation Programme at National University Centre for Organ Transplantation (NUCOT), and in the Department of Urology at NUH. He is also the Surgical Director of NUCOT’s Adult Kidney Transplantation Programme. NPTP’s Deputy Director is Dr Valerie Gan, Programme Director, Pancreas Transplant Programme, and Surgical Director, Kidney Transplant Programme, SingHealth Duke-NUS Transplant Centre (SDTC). Dr Gan is also Senior Consultant, Department of Urology, SGH.
As part of NPTP, a multidisciplinary team of surgeons, physicians and transplant coordinators at both NUCOT and SDTC will screen for patients who are suitable to be placed on the waiting list, and also oversee patients’ pre- and post-operative care. For the initial two-year period, the procedure will be performed at NUH and MOH will review the progress of the programme after two years.
The pancreas transplant service was first introduced in 2012 as a pilot programme supported by the MOH and was a collaboration between NUH and SGH’s transplant units. The pilot programme was then headed by Project Director Prof Krishnakumar Madhavan of NUH. In the same year, the Republic’s very first simultaneous pancreas-kidney (SPK) transplant was successfully performed at NUH. An SPK transplant has been shown to prolong survival in patients with selected type I diabetes and renal failure. SPK helps patients with type I diabetes to be insulin free, improving their quality of life and reducing long-term diabetic complications such as kidney failure, blindness and stroke. Since 2012, five SPK transplants have been performed for type I and type II diabetes mellitus patients.
NUH and SGH will continue to work together to build expertise and experience in pancreas transplantation. This includes rigorous monitoring of clinical outcomes as well as strengthening of transplant education and research. The national programme will also strengthen processes and outreach efforts to ensure that potential patients at all hospitals are identified and screened for pancreas transplant suitability.
A/Prof Tiong said: “The approval of pancreas transplantation as a national programme marks the culmination of several years of clinical efforts and research to bring this life changing surgery to suitable patients suffering from type I diabetes mellitus with complications including renal failure. We will continue to work closely with our SGH colleagues to build expertise and experience in pancreas transplantation, to strengthen it as a sustainable national programme.”
Dr Hersharan Kaur Sran, Senior Consultant, Adult Kidney & Pancreas Transplantation Programme, NUCOT, NUH, said: “Pancreas transplant surgery can add quality of life and years of life to patients with type I diabetes, especially those who also have end-stage kidney failure or have received a kidney transplant. It is thus important to be able to offer this treatment option for patients in Singapore, and to be on par with the best transplant centres worldwide.” She is also the Medical Director of NUCOT’s Adult Kidney Transplantation Programme and a Senior Consultant with NUH’s Division of Nephrology.
“Having been involved in the development and growth of the pancreas transplant service, I am glad to see it become a national programme. This is a timely addition to the range of transplant services that patients should have access to. Patients in need of such a transplant will benefit greatly from the combined knowledge, skill and experience of the teams at NUH and SGH,” said Dr Gan.
First SPK transplant since mainstreaming of service
An SGH patient became the first to undergo an SPK transplant under the national programme in July 2021. The 39-year-old Singaporean The eight-hour surgery was successful. The patient is recovering well and has returned to SGH for follow-up care.
First SPK transplant on type II diabetes patient in 2019
While most of the patients who undergo SPK suffer from type I diabetes, it has been found in recent years that pancreas transplant may also benefit selected type II diabetics patients who are on insulin.
The first SPK transplant for type II diabetes in Singapore was successfully performed at NUH in April 2019. The NUH patient, a 50-year old Singaporean male, suffered from type II diabetes. Despite supposed insulin resistance in type II diabetes, the six-hour surgery was successful in rendering the patient free from dialysis and insulin injections. This is an important advancement in the management of kidney failure for suitable patients with type II diabetes.
The supplementary role of pancreas transplant for kidney failure and insulin-dependent diabetic patients
Some patients with end-stage renal disease requiring dialysis who are suitable for kidney transplant and have insulin-dependent diabetes may undergo evaluation for pancreas transplant. Diabetes is the number one cause of kidney dialysis in Singapore, accounting for about 2 in 3 new cases1 – Singapore is ranked among the top worldwide for diabetes associated end-stage renal failure patients on dialysis.2
After a successful transplantation, the transplanted pancreas should be able to produce sufficient insulin to control the patient’s blood sugar, preventing some diabetes complications. The patient will also not need any insulin injections and will have an improved quality of life with less diet and activity restrictions brought about by diabetes and renal failure.
There are currently three different types of pancreas transplant available under this national programme, namely simultaneous pancreas kidney (SPK) transplant; pancreas transplant alone (PTA) and pancreas after kidney (PAK) transplant.
Pancreas transplants have been carried out in North America, Europe and Asian countries such as Japan and South Korea. Based on the Global Observatory on Donation and Transplantation database, a total of 2,323 pancreas transplants were carried out in North America, Europe, Western Pacific etc in 2019, of which, around 58% were carried out in North America.
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