What is a pancreas transplant?
A pancreas transplant is an operation to place a pancreas into someone whose own pancreas does not function, usually because of type 1, or insulin-dependent, diabetes. In most cases, pancreas transplants are done in combination with a kidney transplant, but they are sometimes done alone.
The pancreas usually comes from someone who has died (a deceased donor), but sometimes a partial pancreas donation may come from a living donor. Sometimes, instead of transplanting a whole or partial pancreas, a large group of pancreas islet cells (the cells that make insulin) is transplanted. The islet cells are usually injected directly into the liver, where they begin to produce insulin. Because these cells make insulin, they may be able to replace the function of the pancreas.
Since the first successful pancreas transplant was done at the University of Minnesota in 1968, a total of over 5,000 pancreas transplants have been performed and the success rates of pancreas transplants have improved steadily. During 2008, more than 400 pancreas transplants were performed at transplant centers in the United States; more than 800 pancreas transplants were done in combination with kidney transplants.
Who is a candidate for a pancreas transplant?
As a rule, pancreas transplants may be considered for people with type 1 diabetes who also have kidney failure and have had (or plan to have) a kidney transplant. Usually, these patients must also meet the medical requirements for kidney transplant, and have significant problems with insulin supplements. In the absence of kidney failure, pancreas-only transplant may be considered appropriate and beneficial in a small number of patients who have severe metabolic complications and failure of other treatment approaches to control their disease.
A pancreas transplant alone (PTA) involves transplanting a pancreas from a person who has died (deceased donor) to a patient with diabetes whose kidneys have not yet been affected by diabetes. This surgery is usually performed on patients with Type I diabetes who experience extreme difficulty controlling their blood sugar levels, or whose risks of surgery and the possible side effects of anti-rejection medications are better than their current state of health. To qualify for a pancreas transplant alone, patients may not only be experiencing great difficulty in controlling glucose levels but also may be having other complications of diabetes. PTA’s are the least common pancreas transplants, and account for about 5% of all pancreas transplants.
At the present time, only people with type 1, or insulin-dependent, diabetes are potential candidates for pancreas transplants. This is because their diabetes is caused by failure of their own pancreas to make enough insulin. The transplanted pancreas will make insulin and correct this situation. People with type 2 diabetes, or non-insulin-dependent diabetes, are not candidates for a pancreas transplant. In type 2 diabetes, the pancreas makes enough insulin, but the body is not able to use it properly.
How long is the wait?
The average wait for a pancreas from a deceased donor is between six months and two yearsThe wait for a pancreas transplant varies depending on a number of factors, such as severity of the illness and availability of a well-matched organ. In most cases, the pancreas comes from someone who has died (deceased donor).
How successful are pancreas transplants?
The success of your pancreas transplant depends on many factors, including your age, how well you follow your transplant team’s instructions, especially regarding taking your medications, and how well your transplant matches your own tissue. One year after the operation, 76 percent of pancreas recipients have a well-functioning transplant and 42 percent have a well-functioning transplant after five years. If you are in optimal health for your transplant, your chances for a successful outcome are as high as 85%.
How much does it cost?
The estimated cost for the first year of a pancreas-only transplant averages $125,800. This includes the cost of the evaluation, procedures to obtain the donated organ, hospital charges, physician fees, follow-up care and anti-rejection medications. After the first year, the average annual cost of follow-up care is about $6,900. Usually, the cost of a pancreas-only transplant is between $51,000.00 and $135,000.00. Although the cost of anti-rejection medications after the surgery can run as high as $2,500.00 per month, you do not have to face your financial concerns alone. Most transplant programs include a financial counselor or social worker who is ready to help you and your family to learn about funding sources to help with the costs of the transplant and after-care.
Medicare provides coverage for pancreas transplants done in combination with a kidney transplant. If you have private insurance, you should check about whether your plan covers transplants. This may also help to pay for part of the cost. 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 transplantation and postoperative treatment—including anti-rejection medications.
How do I start the process?
You start the process by speaking to your doctor about whether a pancreas transplant would be a good treatment choice. You will be referred to a transplant center. You will need to speak to the transplant coordinator at the center, who will arrange a medical evaluation for you. This will help you and your health care team decide whether a pancreas transplant is a good option for you.
For most transplant candidates, the first step after evaluation and acceptance by a transplant center is to get on the national transplant waiting list, which is maintained by the United Network for Organ Sharing (UNOS). All transplant candidates who do not have the choice of a living donor (and even some who do) usually must wait for a period of time because there are not enough donor organs for everyone who needs them.
How am I evaluated for a pancreas transplant?
The benefits of pancreas-only transplantation must outweigh the risks of the surgery and life-long treatment with anti-rejection medications (to prevent rejection of the new pancreas). Patients with type 1 diabetes may be considered for pancreas-only transplantation if they do not have serious associated medical problems, such as major amputations as a result of peripheral vascular disease, or coronary artery disease. You will need to meet with a transplant surgeon and a transplant coordinator at the transplant center. In addition to a medical history review and physical examination by the transplant doctor(s), you may receive:
- Blood tests, including blood and tissue typing
- Blood and urine tests to evaluate your diabetes
- Tests to evaluate your bladder function
- Tests to evaluate your heart and lungs
- A test to check how well your stomach empties after eating
- Tests to check nerve function
- Social/psychological interview to identify your support resources and to identify and resolve potential problems to taking care of yourself and your transplant.
- Eye and dental exam.
If everything goes well, you will be placed on the center’s waiting list until a suitable deceased donor becomes available. You will also be registered with the national computerized registry, which is maintained by United Network of Organ Sharing (UNOS). If a partial pancreas is to come from a living donor, the donor will also need to be evaluated before the operation can be scheduled.
What does the transplant operation involve?
Although it is possible for a living donor to donate a portion of his or her pancreas, most pancreas transplants involve a whole organ from a deceased donor. The donor pancreas is preserved and packed for transport, and must be transplanted into you within fifteen hours. You are put to sleep with a general anesthetic and placed on a breathing machine. Then, an incision is made in the lower part of your abdomen. Your own pancreas is left in place and the new pancreas is transplanted into your lower abdomen and attached to your blood vessels, and intestine or bladder.
The entire surgical procedure for a pancreas transplant takes approximately two to four hours. Since the length of this surgery varies from patient to patient, you should talk with the surgeon ahead of time about what to expect. In the case of a deceased donor transplant, the entire pancreas is removed and transplanted into you. In the case of a partial pancreas transplant, half of the pancreas from a living donor is removed and transplanted into you. In either case, your own pancreas is left in place. In successful pancreas transplants, the new pancreas quickly starts to make insulin, and normal blood sugar levels can be reached within hours.
What should I expect after the transplant?
Because the pancreas is a complex organ, you may be admitted to the intensive care unit following the transplant for careful monitoring of your blood sugars. Most patients are discharged within seven to 14 days if the post-operative course has been smooth and there is no sign of infection or rejection. Remember that you will need to take special medicines, called immunosuppressive or anti-rejection medications, following your transplant surgery to help prevent your body from rejecting your newly transplanted organ. It is necessary to take these medications exactly as the doctor prescribes for the rest of your life. In addition, you will have regularly scheduled tests as an outpatient to monitor the function of your transplanted organ and will be encouraged to maintain a healthy lifestyle through diet and exercise. You will no longer need to take insulin shots. In addition, research studies show that good functioning of the new pancreas may help to stabilize the progression of some of the long-term complications of diabetes such as diabetic eye disease and nerve damage.
What complications may occur?
The main complications are infection and rejection.
One of the most important ways for you to help to protect your new pancreas transplant is for you to take the medications prescribed for you. Try to learn more about your post-transplant medications, some of which may include:
While the risk of rejecting your new pancreas decreases as time goes on, it never goes away. The symptoms of rejection you need to watch for may include:
- Tenderness in the area of the transplant
- Increase in blood glucose
- Abdominal pain
If you have any of these, speak to your transplant team right away. You will be seen regularly at the transplant center and may continue to see your primary health care team. Sometimes, early symptoms of rejection are hard to notice, but they can be detected in your blood work and treated. Most pancreas transplant patients will have at least one rejection episode during the first few months, and need to return to the hospital for treatment.
The medications you need to take to prevent your body’s rejection of the new pancreas may also lower your body's immune defenses. This increases your chances of getting an infection. This risk is higher right after your transplant because the doses of your anti-rejection medications are high. During this time, it is important to avoid large crowds and people who are sick, especially those with contagious diseases such as colds or flu. You should wash your hands often. The doses of your medications will be gradually reduced, and the chance of getting infections will be lower but always present.
Do the anti-rejection medications have side effects?
Yes. These medications 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 medications you are taking. It is important to learn the side effects that each of your medications may cause, and to understand what to do if you get any of them.
Some side effects are more serious than others, and require an immediate call to your transplant team as well as 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 minimize side effects.
How can I cope with fears of rejection and other concerns?
Although a pancreas transplant can offer recipients a new lease on life, it is normal to experience some stress after the transplant. This may include fear of your body rejecting the transplant, concerns about returning to work or other activities, and feelings of isolation. Here are some strategies that may help you cope with these and other challenges:
- Join a local support group for transplant recipients. Talking with others in a situation similar to yours, can be supportive, informative and can decrease fears
- Learn as much as possible about and be involved in your medical care and progress.
- Find personal quiet time to think about your feelings, identify concerns and plan for the adjustments you need to make.
- Get to know the members of your transplant team, and discuss the issues that most concern you
- Read and learn whatever you can about transplant-related issues.
- Do not be afraid to seek help in dealing with stressful situations that can arise.
- Share helpful personal experiences and new information with other patients.
Can I return to work and other activities after the transplant?
Patients may return to their previous employment, start a new job or work part-time. If this is not possible, however, there are many other ways to feel productive. This might include continuing your education, pursuing a hobby, volunteering, starting an exercise program, or spending quality time with family and friends. If returning to work is an option, you may find it helpful to speak to the social worker at your transplant center 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 to members of the health care team at your transplant center.