What to Expect From a Pancreas Transplant

Understanding the Process of Pancreas Transplantation

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

If your doctors 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, so it's important to weigh the risks and 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.

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

  • Frequent, acute, and severe metabolic complications such as very high glucose, 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. About 10% 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 as well as a pancreas simultaneously.

Pancreas transplant after a kidney transplant

If a donor pancreas is not available, but a kidney is, a kidney transplant will be done first and the pancreas transplant will be done 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 islet cells from the organ 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.

In 2017, 213 pancreas transplants and 789 simultaneous pancreas/kidney transplants were performed in the United States.

Donor Recipient Selection Process

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 waiting time depends on your blood group and how long it takes for a suitable donor—one whose blood and tissue types match yours—to become available. If the testing indicates a need for a transplant, as well as the ability to survive the surgery and recover with a good outcome, and if additional qualifications are met such as the ability to afford the surgery and the ability to manage the medications needed after surgery, you will be placed on the transplant list until an organ becomes available. 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:

  • The 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.
  • The distance between donor and transplant hospitals. 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.

The number of pancreata (plural of pancreas) available for transplant is, unfortunately, small. Currently, more people are in need of a healthy pancreas than can be provided for with donors. The wait for a pancreas can be quite long—on average, about three years.

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. Here's what you can do:

  • 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 doctor if you need help quitting.
  • 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 donors.

Before Surgery

Seeing a transplant surgeon requires a referral from your own physician to the transplant center that performs pancreas transplants near your home. In many cases, there may only be one nearby, but in large cities, you may have multiple options. The referral is typically made by your endocrinologist, a physician specializing in the treatment of hormone issues, or a gastroenterologist. A referral can also be made by primary care and other specialists involved in your treatment.

After meeting with the staff at a 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 to have the kidney transplant first, followed by the pancreas transplant later. The option that's right for you depends on the severity of your kidney damage, the availability of donors, and your preference.

Once a donor pancreas becomes available, it must be transplanted into a recipient within 18 to 24 hours. You should keep a packed hospital bag handy and make arrangements for transportation to the transplant center in advance. If you're waiting for a donated pancreas, make sure the transplant team knows how to reach you at all times.

Surgical Process

The surgery to place a pancreas into the recipient begins with the patient being intubated and placed on a ventilator along with the administration of general anesthesia. Once the patient is asleep, the procedure can begin. 

The surgeon will make an incision down the center of your abdomen. He or she 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.

The patient’s own pancreas, referred to as the “native pancreas,” remains in place unless there is a specific reason to remove it, as it will still aid digestion. Once the pancreas is attached to the intestine and blood vessels, the incision can be closed and the patient is taken to the intensive care unit (ICU) to be closely monitored during their recovery.

Typically, the transplanted pancreas rests closer to the belly button than the original pancreas, which is found deeper in the abdomen. This placement in the front of the abdomen allows a biopsy to be easily taken in the future, if necessary.

The surgical team will monitor your heart rate, blood pressure, and blood oxygen levels throughout the procedure.

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.

Complications 

The risks associated with pancreas transplants are more significant than many standard surgeries, as the patient is often sicker prior to surgery and the procedure is complex. These risks are in addition to the standard risks that patients face when having any surgery, and the risks associated with general anesthesia:

  • Infection
  • Poor glucose control
  • Bleeding
  • Blood Clots
  • Rejection of new organ
  • Organ failure
  • Nausea
  • Vomiting
  • Diarrhea
  • Reaction to anesthesia
  • Difficulty weaning from the ventilator
  • Blood clots
  • Bleeding
  • Infection
  • 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 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.

After a successful pancreas transplant, your new pancreas will make the insulin your body needs, so you'll no longer need insulin therapy to treat type 1 diabetes. But even with the best possible match between you and the donor, your immune system will try to reject your new pancreas.

To avoid rejection, you'll need anti-rejection medications to suppress your immune system. Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral, and antifungal medications.

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

If you experience any of these symptoms, notify your transplant team immediately.

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.

Pancreas rejection rates tend to be slightly higher among pancreas-only transplant recipients. It's unclear why results are better for those who receive a kidney and pancreas at the same time. Some research suggests that it may be because it's more difficult to monitor and detect rejection of a pancreas alone versus a pancreas and a kidney.

Side effects of Immunosuppressants 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

Prognosis

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

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 they are 73% and 56%, respectively, for simultaneous pancreas–kidney transplants; 64% and 38%, respectively, for pancreas after kidney; and 53% and 36%, respectively, for pancreas transplants alone. Recipients who reach the one-year mark with a functioning transplant have a much higher probability for long-term function. Functioning means there was no need for insulin, glucose levels were normal when tested, and hemoglobin a1c results were normal or slightly elevated.

Overall survival rates are about 95% to 98% at one year, 91% to 92% three years after transplant, and 78% to 88% at five years. The majority of deaths are 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.

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.

Taking good care of overall health by eating well, following the surgeon's instruction, and routinely exercising are important. Taking care of your emotional health after transplant is also important, and often gets overlooked in the effort to be physically well. 

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.

Support and Coping

It's normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work, or other issues after a transplant. Seeking the support of friends and family members can help you cope during this stressful time.

Your transplant team can also assist you with other useful resources and coping strategies throughout the transplant process, such as:

  • Joining a support group for transplant recipients. Talking with others who have shared your experience can ease fears and anxiety. Support groups may be in-person or online.
  • Finding vocational rehabilitation services. If you're returning to work, your social worker may be able to connect you with rehabilitation services provided by your home state's department of vocational rehabilitation.
  • Setting realistic goals and expectations. Recognize that life after transplant may not be exactly the same as life before transplant. Having realistic expectations about results and recovery time can help reduce stress.
  • Educating yourself. Learn as much as you can about your procedure and ask questions about things you don't understand. Knowledge is empowering.

Diet and nutrition

After your pancreas transplant, you should adjust your diet to keep your pancreas healthy and functioning well. Maintaining a healthy weight through diet and exercise can help prevent many common post-transplant complications, including infection, heart attacks, and bone thinning.

Your transplant team should include a nutrition specialist (dietitian) who can discuss your nutrition and diet needs and answer any questions you have after your transplant. Your dietitian's recommendations may include:

  • Eating at least five servings of fruits and vegetables each day
  • Eating lean meats, poultry and fish
  • Eating whole-grain breads, cereals and other products
  • Having enough fiber in your daily diet
  • Drinking low-fat milk or eating other low-fat dairy products to help maintain healthy calcium levels
  • Limiting salt and sodium intake by using fresh herbs and spices to season foods and avoiding processed foods
  • Limiting unhealthy fats, such as saturated fats in butter and red meats
  • Limiting your caffeine and avoiding excessive alcohol intake
  • Staying hydrated by drinking adequate water and other fluids each day
  • Avoiding grapefruit and grapefruit juice, pomegranate and Seville oranges due to their effect on a group of immunosuppressive medications called calcineurin inhibitors
  • Following food safety practices to reduce the risk of infection

Exercise

Exercise and physical activity should be a regular part of your life after a pancreas transplant to continue improving your overall physical and mental health.

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

Your transplant team will recommend a physical activity program based on your individual needs and goals.

Walking, bicycling, swimming, low-impact strength training, and other physical activities you enjoy can all be a part of a healthy, active lifestyle after transplant. But be sure to check in with your transplant team before starting or changing your post-transplant exercise routine.

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.

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