What to Expect From a Pancreas Transplant

Those with type 1 diabetes that is not responding to standard treatment with insulin may be eligible for a pancreas transplant—a complex procedure in which the pancreas from a deceased donor is surgically placed into a recipient with the goal of restoring insulin production and eliminating the disease's often severe complications.

If your healthcare providers determine that you are a candidate for pancreas transplantation, you will be placed on a waiting list while you wait for a pancreas to become available; this can take several years. After the surgery, you will take immunosuppressive medications for the rest of your life in order to avoid the body's rejection of the new organ.

While pancreas transplants are very effective in most cases, waiting for a donated organ can be stressful, and the surgery involves serious risks. It's important to weigh them alongside the benefits before initiating the transplant process.

Reasons for a Pancreas Transplant

The majority of people with type 1 diabetes are able to maintain well-controlled glucose levels with insulin injections and pumps. It is when the severity of the disease has reached the point where the patient is very ill, and medication cannot provide better disease control, that a transplant may be warranted.

After a successful pancreas transplant, the new pancreas will make the insulin the body needs, meaning insulin therapy will no longer be needed.

According to the American Diabetes Association (ADA), the qualifications for a pancreas transplant include:

• Frequent, acute, and severe metabolic complications such as very high or very low glucose, or ketoacidosis, as a result of type 1 diabetes
• Failure of insulin to prevent acute complications such as eye disease, severe neuropathy, and renal failure
• A patient's inability to comply with insulin therapy due to significant physical or emotional challenges

A pancreas transplant usually isn't a treatment option for people with type 2 diabetes, except in rare cases when the person has low insulin resistance and low insulin production. Only about 9% of all pancreas transplants are performed in people with type 2 diabetes.

Who Is Not a Good Candidate?

Undergoing an organ transplant of any kind involves serious risks, and pancreas availability is very limited, so only people who truly qualify are candidates.

Those who are not eligible for pancreas transplantation include:

• People with cancer
• People who are at high or moderate risk of recurrence after being treated for cancer
• People with an untreated systemic infection or chronic infection, making immunosuppression unsafe
• People with psychosocial conditions or chemical dependency affecting their ability to adhere to therapy

Types of Pancreas Transplants

The most common type of pancreatic transplant involves removing the pancreas from a donor and transplanting part of it or all of in the recipient. Often, a patient will undergo a kidney transplant at the same time.

The various types of procedures include:

• Pancreas transplant only: People with diabetes and early or no kidney disease may be candidates for a solitary pancreas transplant. This surgery involves the placement of part of or a whole healthy pancreas into a recipient whose pancreas is no longer functioning properly.
• Combined kidney-pancreas transplant: For people with diabetes who have kidney failure, surgeons sometimes transplant a kidney and a pancreas simultaneously.
• Pancreas transplant after kidney transplant: If donor kidney is available before a pancreas, the kidney transplant will be done first. The pancreatic transplant would then be done at a later time once an organ becomes available.
• Pancreatic islet cell transplant: During a pancreatic islet cell transplant, the pancreas is removed from a donor and only the organ's islet cells are transplanted via a vein in the recipient's kidney. This procedure is still being studied and is performed in the United States only in clinical trials sanctioned by the U.S. Food and Drug Administration (FDA).

Donor Recipient Selection Process

If testing indicates a need for a pancreatic transplant, you will be considered for the transplant list. Factors that will be taken into account when making this decision, in addition to the ADA qualifications listed above, include whether you:

• Have the ability to survive the surgery and recover with a good outcome
• Can manage the medications needed after surgery
• Can afford the surgery

Once you've been accepted as a candidate for a pancreas transplant, your name will be placed on a national list of people awaiting a transplant. The United Network for Organ Sharing (UNOS) has a computer matching system that facilitates this process and determines a patient's order on the waiting list.

Before an organ is allocated, the following factors are considered:

• Compatibility of the donor and recipient in terms of blood type, body type, and other medical factors
• Proper organ size: A pancreas for a child, for example, will not be suitable for most adults.
• Location: The distance between donor and transplant hospitals is important, as organ transplants are most successful when preservation and transport time are short. In general, local candidates get organ offers before those listed at more distant hospitals.

Once a pancreas is confirmed viable for a recipient, the recipient is notified and asked to report to their transplant center.

Smart Strategies

Whether you're waiting for a donated pancreas to become available or your transplant surgery is already scheduled, it's important to stay as healthy as possible to increase your chances of a successful transplant.

• Take your medications as prescribed.
• Follow your diet and exercise guidelines, and maintain a healthy weight.
• If you smoke, make a plan to quit. Talk to your healthcare provider if you need help with cessation.
• Keep all appointments with your healthcare team.
• Stay involved in healthy activities, including those that benefit your emotional health, such as relaxing and spending time with family and friends.

Types of Donors

The majority of pancreas transplants are done using a whole organ from a deceased donor. In some cases, a segment of the pancreas from a live donor can be used; these typically come from a donor who is a friend or relative who wants to help the recipient.

People with diabetes cannot be donors, nor can those with certain infections or chronic diseases. This goes for living or deceased individuals.

Before Surgery

Seeing a transplant surgeon requires a referral from your healthcare provider. This is typically your endocrinologist or gastroenterologist, though it may be your primary care doctor or another specialist involved in your treatment.

The surgeon will be in a transplant center that performs this procedure near your home. In many cases, there may only be one nearby; in large cities, you may have multiple options.

After meeting with the staff at the transplant center, you will be evaluated. This will include a review of your medical records, blood tests, possible imaging studies, and other tests designed to determine if you are well enough to tolerate transplant surgery but sick enough to need a new organ.

When you consider transplant centers, you may want to:

• Learn about the number and type of transplants the center performs each year
• Ask about the transplant center's organ donor and recipient survival rates
• Compare transplant center statistics through the database maintained by the Scientific Registry of Transplant Recipients
• Consider other services provided by the transplant center, such as support groups, travel arrangements, local housing for your recovery period, and referrals to other resources

If you need a kidney transplant too, the transplant team will determine whether it's better for you to have the pancreas and kidney transplants during the same surgery or separately. The option that's right for you depends on the severity of your kidney damage, the availability of donors, your preference, and other factors.

Surgical Process

Pancreas transplant surgery usually lasts about three to six hours, depending on whether you are having a pancreas transplant alone or kidney and pancreas transplants at the same time.

The surgical team will monitor your heart rate, blood pressure, and blood oxygen levels throughout the procedure, so you will be hooked up to all relevant monitoring systems. The surgery to place a pancreas begins with you being intubated, placed on a ventilator, and given general anesthesia. Once you are asleep, the procedure can begin.

The surgeon will make an incision down the center of your abdomen. They will then place the new pancreas and a small portion of the donor's small intestine into your lower abdomen.

The donor intestine is attached to either your small intestine or your bladder, and the donor pancreas is connected to blood vessels. If you're also receiving a kidney transplant, the blood vessels of the new kidney will be attached to blood vessels in the lower part of your abdomen.

Your own pancreas, referred to as the native pancreas, actually remains in place unless there is a specific reason to remove it, as it will still aid digestion. Typically, the transplanted pancreas rests closer to the belly button than the original pancreas, which is found deeper in the abdomen. This placement allows a biopsy of the new organ to be easily taken in the future, if necessary.

Once the donated pancreas is attached to the intestine and blood vessels, the incision is closed and you are taken to the intensive care unit (ICU) to be closely monitored during their recovery.

Complications

The risks associated with pancreas transplants are more significant than many standard surgeries, as patients are often sicker prior to surgery and the procedure is complex.

Here are some of the standard risks patients face when having any surgery, including those specifically associated with general anesthesia and this procedure:

• Infection
• Poor glucose control
• Bleeding
• Blood clots
• Rejection of new organ
• Organ failure
• Nausea
• Vomiting
• Diarrhea
• Reaction to anesthesia
• Difficulty weaning from the ventilator
• Excess sugar in the blood (hyperglycemia) or other metabolic problems
• Urinary complications, including leaking or urinary tract infections
• Failure of the donated pancreas
• Rejection of the donated pancreas

After Surgery

You will spend several days in ICU after a pancreas transplant procedure and at least seven days in the hospital before going home to continue your recovery. Most patients return to their normal activities within four to six weeks of surgery.

Even with the best possible match between you and the donor, your immune system will try to reject your new pancreas. To avoid this, you'll need anti-rejection medications to suppress your immune system. Because these drugs make your body more vulnerable to infection, your healthcare provider may also prescribe antibacterial, antiviral, and antifungal medications.

Side effects of immunosuppressants (calcineurin inhibitors) include:

• Bone thinning (osteoporosis)
• High cholesterol
• High blood pressure
• Nausea, diarrhea, or vomiting
• Sensitivity to sunlight
• Puffiness
• Weight gain
• Swollen gums
• Acne
• Excessive hair growth or loss

Signs and symptoms that your body might be rejecting your new pancreas include:

• Belly pain
• Fever
• Excessive tenderness at the transplant site
• Increased blood sugar levels
• Decreased urination
• Nausea
• Vomiting
• Dark urine
• Decreased urine output

It's not unusual for pancreas transplant recipients to experience an acute rejection episode within the first few months after the procedure. If you do, you'll need to return to the hospital for treatment with intensive anti-rejection medications in an effort to preserve the organ.

If your new pancreas fails, you can resume insulin treatments and consider a second transplant. This decision will depend on your current health, your ability to withstand surgery, and your expectations for maintaining a certain quality of life.

Prognosis

Overall, the outcomes that patients experience after pancreas transplantation are quite good.

Organ Rejection

One of the more challenging aspects of life and health after a transplant is the prevention of rejection of the organ. Frequent visits to the transplant center are typical after surgery and are less frequent as time passes unless there are issues with the new organ. For many, a return to normal life is possible after surgery, but others may find that they are improved, but still unwell.

According to a 2017 report in the American Journal of Transplantation, the overall incidence of first acute rejection in pancreas recipients decreased from 16.5% in 2009 to 2010 to 14.6% in 2013 to 2014.

Function and Survival

An analysis of 21,328 pancreas transplants from the International Pancreas Transplant Registry—performed from 1984 to 2009—looked at pancreas function rates at five and 10 years and found the following:

Recipients who reached the one-year mark with a functioning transplant had a much higher probability for long-term function. "Functioning" was defined as:

• No need for insulin
• Glucose levels are normal when tested
• Hemoglobin A1C results are normal or slightly elevated

The majority of deaths were due to cardiovascular disease, rather than complications from surgery, and occurred more than three months after being discharged from the transplant facility.

Survival rates vary by procedure type and transplant center. The Scientific Registry of Transplant Recipients maintains current statistics regarding transplantation for all U.S. transplant centers.

Support and Coping

Waiting for an available pancreas, as well as undergoing and recovering from the transplant itself is a stressful experience, both physically and emotionally. It's important to seek the support of friends and family members.

Your transplant team will be able to provide useful resources and offer coping strategies throughout the transplant process as well. Recommendations might include:

• Staying well-informed: Learn as much as you can about your transplant and ask questions about anything you don't understand.
• Joining a support group for pancreas transplant recipients: Talking with others who have shared your experience can ease fears and anxiety; in-person as well as online support groups exist. UNOS's website offers some great places to start.
• Recognizing that life after a transplant may not be exactly the same as life before one: Having realistic expectations about results and recovery time can help reduce stress. Your team can help you define your personal expectations.

Diet and Nutrition

After your pancreas transplant, you'll need to eat healthily to keep your pancreas healthy and functioning well, and to help stave off complications like high cholesterol and bone-thinning.

You may need increased amounts of protein and calories right after the transplant to help with wound-healing and mitigate the toll of the procedure on your body. Be sure to eat nutritious foods such as lean beef and pork, chicken, turkey, and fish; low fat milk and yogurt; eggs; nuts; whole grain breads and cereals; and fruits and vegetables.

It is possible that you'll need to restrict your sodium, potassium, or fluid intake until your pancreas gains full function.

Because anti-organ rejection medications can affect bone health, you may be required to eat calcium-rich foods, such as low-fat dairy products, or take calcium supplements.

Your transplant team should include a nutrition specialist, or dietitian, who can discuss your specific dietary needs in detail.

Exercise

You should be able to start exercising about six weeks after your surgery, though your transplant team will advise you on when it's safe to start and which exercises are most suitable for you.

Regular exercise helps boost energy levels and increase strength, as well as helping you maintain a healthy weight, reduce stress, and prevent common post-transplant complications such as high blood pressure and high cholesterol levels.

A Word From Verywell

A pancreas transplant is a very serious procedure with a lifelong impact on health and wellbeing. For many, the transplant is a solution to a very serious problem and leads to a major improvement in quality of life. Less commonly, the procedure leads to complications, poor health, and for some, no improvement in glucose control.

It is important to weigh the current impact of pancreatic disease against the potential rewards and complications that come with a transplant and proceed with caution after learning as much as possible about the procedure.