Pancreas Transplant

Why it’s done

A pancreas transplant can restore normal insulin production and improve blood sugar control in people with diabetes, but it’s not a standard treatment. The side effects of the anti-rejection medications required after a pancreas transplant can often be serious.

Doctors may consider a pancreas transplant for people with any of the following:

• Type 1 diabetes that cannot be controlled with standard treatment
• Frequent insulin reactions
• Consistently poor blood sugar control
• Severe kidney damage
• Type 2 diabetes associated with both low insulin
• resistance and low insulin production

Risks

Complications of the procedure

Pancreas transplant surgery carries a risk of significant complications, including:

• 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

Anti-rejection medication side effects

After a pancreas transplant, you’ll take medications for the rest of your life to help prevent your body from rejecting the donor pancreas. These anti-rejection medications can cause a variety of side effects, including:

• Bone thinning (osteoporosis)
• High cholesterol
• High blood pressure
• Nausea, diarrhea or vomiting
• Sensitivity to sunlight

Other side effects may include:

• Puffiness
• Weight gain
• Swollen gums
• Acne
• Excessive hair growth or loss

Anti-rejection drugs work by suppressing your immune system. These drugs also make it harder for your body to defend itself against infection and disease.

How you prepare

Choosing a transplant center

If your doctor recommends a pancreas transplant, you’ll be referred to a transplant center. You’re also free to select a transplant center on your own or choose a center from your insurance company’s list of preferred providers.

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

What you can expect

During the procedure

Surgeons perform pancreas transplants with general anesthesia, so you will be unconscious during the procedure. The anesthesiologist or anesthetist gives you medication as a gas to breathe through a mask or injects a liquid medication into a vein.

After you’re unconscious:

• An incision is made down the center of your abdomen.
• The surgeon places 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 that also supply blood to your legs.
• Your own pancreas is left in place to aid digestion.
• 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 new kidney’s ureter — the tube that links the kidney to the bladder — will be connected to your bladder. Unless your own kidneys are causing complications, such as high blood pressure or infection, they’re left in place.

The surgical team monitors your heart rate, blood pressure and blood oxygen 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.

After the procedure

After your pancreas transplant, you can expect to:

• Stay in the intensive care unit for a couple of days. Doctors and nurses monitor your condition to watch for signs of complications. Your new pancreas should start working immediately, and your old pancreas will continue to perform its other functions.If you have a new kidney, it’ll make urine just like your own kidneys did when they were healthy. Often this starts immediately. But in some cases, it may take up to a few weeks to reach normal urine production.
• Spend about a week in the hospital. Once you’re stable, you’re taken to a transplant recovery area to continue recuperating. Expect soreness or pain around the incision site while you’re healing.
• Have frequent checkups as you continue recovering. After you leave the hospital, close monitoring is necessary for three to four weeks. Your transplant team will develop a checkup schedule that’s right for you. During this time, if you live in another town, you may need to make arrangements to stay close to the transplant center.
• Take medications for the rest of your life. You’ll take a number of medications after your pancreas transplant. Drugs called immunosuppressants help keep your immune system from attacking your new pancreas. Additional drugs may help reduce the risk of other complications, such as infection and high blood pressure, after your transplant.

Results

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. You’ll likely take these drugs for the rest of your life. Because medications to suppress your immune system make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.