What is a simultaneous kidney-pancreas transplant (SKP)?
A kidney-pancreas transplant is an operation to place both a kidney and a pancreas at the same time into someone who has kidney failure related to type 1 diabetes.
In many cases, both transplanted organs may come from one deceased donor. However, it is also possible for the kidney to come from a living donor (a family member or friend) and the pancreas from a deceased donor.
This type of transplant treats both kidney failure and diabetes because the new organs replace the function of the failed kidney and the pancreas. The first successful kidney-pancreas transplant in the United States took place in 1966. Since then, many of these operations take place each year. In 2012, about 800 were done at transplant centers in the United States.
Who is a candidate for SKP?
Adults who have kidney failure because of type 1 diabetes are possible candidates for a kidney-pancreas transplant. In type 1 diabetes, the pancreas does not make enough insulin, a hormone that controls the blood sugar level in your body. The transplanted pancreas can make insulin and correct this type of diabetes.
People with type 2 diabetes are not candidates for a combined kidney-pancreas transplant. In type 2 diabetes, the pancreas makes insulin, but the body is not able to use this insulin very well. For this reason, a pancreas transplant would not help to correct type 2 diabetes. However, people with this type of diabetes can still have a kidney transplant if they have kidney failure because of their diabetes.
What are the medical signs for SKP?
Usually, a patient who needs dialysis, or has an estimated e-GFR near 20/mL/min or less. The transplant center where you have your evaluation will provide more information about this.
Which patients may not be considered for SKP transplantation?
A kidney-pancreas transplant is usually NOT an option in a person with:
- HIV infection
- Active cancer
- Does not follow treatment
- Substance abuse problems
- Severe mental retardation
- Severe heart disease and/or severe blood vessel disease.
Is it possible to have kidney and pancreas transplants at different times?
Yes. Sometimes, a patient who has kidney failure because of type 1 diabetes may have a kidney transplant first, followed by a pancreas transplant at a later date.
How long is the wait?
The waiting time for a kidney-pancreas transplant varies, depending on your blood group and how long it takes for a suitable deceased donor to become available. According to the United Network for Organ Sharing (UNOS), the average wait for a pancreas is about 3 1/2 years, while the wait for a combined kidney and pancreas is about 3 years. As of September 2013, there are more than 2,000 candidates listed on the national waiting list awaiting a kidney-pancreas transplant.
How successful are kidney-pancreas transplants?
The national average for survival rates of kidney pancreas transplants in adults is 95% still functioning well one year after the operation, and 92.5% at three years.
The best results are usually seen with a closely matched kidney from a living donor (usually from a sibling). The next best results are seen with a kidney from a less closely matched living donor (such as a spouse or friend). The success rates are also good for combined kidney-pancreas transplants from deceased donors. The best results are usually seen when both the pancreas and a kidney come from the same donor: a deceased donor. This is because the risk of rejection is greatly reduced. However, there have been many transplants performed using a living donor, with one kidney and a pancreas segment being donated.
How much does it cost?
The total costs average $474,700 for kidney-pancreas transplants. This includes: the evaluation, getting the organ, hospital stay, doctor fees and follow-up care and medicine for the 180 days. Medicare pays for many of the kidney-pancreas transplant costs. If you have private insurance, you should check with your insurance agent about coverage for this transplant. This may help to pay for some of the costs. The social worker or a financial counselor at your transplant center may be able to help you find local, state or national programs that can help with the costs of the transplant and post operation treatment, including needed medicines.
How do I start the process?
You start the process by speaking to your doctor about whether a kidney-pancreas transplant would be a good treatment choice for you. You will be referred to a transplant center. You will need to speak to the transplant coordinator at the center, who will make plans for you to have a complete medical evaluation. This evaluation will help you and your health care team decide whether the transplant would be a good choice for you.
How am I evaluated for a kidney-pancreas transplant?
In general, patients with type 1 diabetes and kidney failure are considered for kidney-pancreas transplants only if they do not have other serious problems related to diabetes, such as heart disease or severe blood vessel disease.
You will meet with many transplant team members including a transplant surgeon, a kidney doctor, a transplant coordinator and a social worker at the transplant center. In addition to a medical history review and physical examination, you may receive:
- Blood tests, including blood and tissue typing
- Tests to evaluate your diabetes. This will confirm that you have type 1 diabetes
- Evaluation of your kidneys, including a 24-hour urine test if you are not on dialysis
- Tests of your heart and lung function
- Social and psychological evaluation
- Neurological tests to evaluate loss of sensation in hands and feet
- Eye and dental exam. The transplant center will provide more information about now this condition affects your candidacy.
If all the tests go well, you will be accepted for a kidney-pancreas transplant and placed on the transplant center's waiting list. You will also be registered on the national computerized registry, which is maintained by UNOS (United Network for Organ Sharing).
What does the operation involve?
In the kidney-pancreas transplant operation, the pancreas is placed on the right side of your lower abdomen and the kidney is placed in the left side of the lower abdomen. Usually, your own kidneys and pancreas are not removed.
The surgical procedure usually lasts four to six hours, and your hospital stay is usually two to four weeks. After the surgery, the pancreas begins to make insulin within hours, and the blood sugar is controlled. From this point on, insulin shots are usually not needed unless the body rejects the new pancreas. Studies show that good function of the new pancreas may help slow the spread of other problems related to diabetes, such as nerve and eye damage, and decrease the chance that diabetic changes may take place in the transplanted kidney.
What should I expect after the operation?
The care after a kidney/pancreas transplant is very similar to a kidney transplant alone. One difference is that after a kidney/pancreas transplant you may spend a day or so in the intensive care unit (ICU) for close watching to make sure both kidney and pancreas are working well. If there are no problems such as rejection or infection, you should be able to go home in seven to ten days. Remember that you will need to take special medicines, called immunosuppressive or anti-rejection medications, following your transplant operation to help prevent your body from rejecting your newly transplanted organs. You need to take these medicines exactly as the doctor prescribes for the rest of your life. In addition, you will have regularly scheduled tests as an outpatient to check the function of your transplanted organs and you will be told to follow a healthy lifestyle through diet and exercise.
What problems may occur?
The main problems that may occur are infection and rejection. In order to prevent rejection, it is important to take your medicine exactly as ordered by your doctor. The symptoms of rejection you need to watch for may include tenderness around the transplanted organs, decreased urine output, increase in blood sugar level, fever, belly pain and vomiting.
If you have any of these symptoms, speak to your transplant team right away. You will be evaluated regularly at the transplant center. Sometimes, early symptoms of rejection are hard to notice, but they can be found in your blood work and treated. Most kidney-pancreas transplant patients will have a rejection episode during the first few months, and they will need to return to the hospital for treatment.
The medications you need to take to prevent rejection lower your body's immune defenses, which increases your chance of getting an infection. This risk is higher right after your transplant because the doses of your medications are higher. During this time, it is important to avoid large crowds and people who are sick, especially with contagious illnesses such as colds or flu. You should wash your hands often. After a while, the doses of your medicines will be reduced, and the chance of getting infections will be less.
Do the anti-rejection medicines have side effects?
Yes. These medicines have many potential side effects. All of them can increase your chances of getting infections (see previous question). Other side effects depend on the specific medicines you are taking. It is important to learn the side effects that each of your medicines may cause and understand what to do if you have any of them. Some side effects are more serious and require an immediate call to your transplant team and quick adjustments in your medications. Other side effects may be more of a bother, but not life-threatening, and they can be dealt with at your next clinic visit. Ask your transplant team what to do to help lower side effects.
How can I cope with fears about rejection and other concerns?
Although transplantation gives most recipients a new lease on life, with added freedom and increased energy and productivity, it is normal to experience some stress. For example, it is not unusual to have fears about rejection, concerns about returning to work and other activities, and feelings of isolation. Here are some ways that may help you to better cope with these and other challenges:
- Join a local support group for transplant recipients
- Learn as much as possible about and be involved in your medical care and progress
- Find personal quiet time to think about your feelings, and the things that worry you and plan for the changes you need to make
- Get to know the members of your transplant team, and talk to them about the things that worry you most.
Can I return to work and other activities after the transplant?
It may be possible to return to your previous job, start a new job or work part-time. However, if this is not possible, there are many other types of fulfilling and productive activities you can look into. These may include going back to school, finding hobbies, volunteering, starting an exercise program, traveling or spending quality time with family and friends. If you are able to return to work, you may want to ask the transplant social worker at your center for information about the rehabilitation services provided through your state's Department of Vocational Rehabilitation.
Other sources of help and information
If you have questions or problems, you should speak with your doctor or another member of the health care team at your transplant center. You may also check the following resources for additional general information and information about financial assistance:
National Kidney Foundation
United Network for Organ Sharing
Help Hope Live
(if you are a veteran and received your transplant at a VA Hospital)
Insurance for High Risk Individuals
1-877-222-VETS (8387) www.va.gov
American Kidney Fund
(American Medical Support Flight Team)
The following NKF publications may be helpful. Copies are available by contacting your local NKF affiliate, calling the national toll-free number 1.855.NKF.CARES (1.855.NKF.CARES).
- New-Onset Diabetes
- Kidney Transplant
- How to Write to Donor Families
- Nutrition and Transplantion
- Waiting for a Transplant Booklet
- From Illness to Wellness: Life after Transplantation
- Transplant Chronicles a quarterly E-newsletter for transplant recipients and their families.
You may also be interested in learning more about NKF's transAction Council. The council provides recipients and their families with information and programs in education, fitness and research designed to improve their quality of life. Membership in the council is free and open to all individuals who have received a life-saving or life-enhancing organ transplant, and to their families and friends. For more information about the benefits of membership and to receive a membership form, call the National Kidney Foundation.
Date Reviewed: November 2013
If you would like more information, please contact us.
© 2014 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.