About Pancreas Transplant

If you or someone you know is considering a pancreas transplant, it is important that you completely understand the benefits, risks, and limitations of transplantation so you can make an informed decision.

Your success as a pancreas transplant recipient depends in part on your understanding of what to expect before, during, and after your transplant surgery.

Pancreas Transplant Program

Kidney-pancreas transplant is a possible treatment option for patients with type 1 diabetes who are on, or close to requiring, dialysis. A kidney-pancreas transplant can improve the quality of life for such patients. With a new kidney, you will no longer experience renal failure, and your new pancreas will maintain your blood sugars at a normal level. Kidney-pancreas transplantation is a chance to return to a more normal, productive lifestyle.

The Healthy Pancreas

Your pancreas is a slender gland located between your stomach and spinal cord. The pancreas performs two major functions. First, it secretes two substances that control the amount of blood sugar in your body: insulin and glucagon. Insulin helps your body absorb sugar from the blood into your cells to produce energy. This process lowers your blood sugar. Glucagon, on the other hand, raises blood sugar by stimulating sugar production in various organs. The other function of your pancreas is to produce enzymes that are secreted into the small intestine to aid digestion.

Diabetes and Its Effect On the Kidneys

Diabetes mellitus is a disease in which the pancreas produces little or no insulin, or the pancreas makes insulin but the body is unable to use that insulin properly.

There are two types of diabetes. Type 1 diabetes occurs early in life, usually by age 25. In type 1 diabetes, your body's immune system attacks the insulin-producing cells of the pancreas. As a result, your pancreas makes little or no insulin, causing the level of your blood sugar to rise. Type 1 diabetics must use insulin injections or an insulin pump to help control blood sugar.

Type 2 diabetes occurs later in life. In type 2, although the pancreas still makes insulin, the body resists the action of that insulin. One key difference between type 1 and type 2 is that type 2 is easier to control, usually by diet and exercise. When these are not effective by themselves, patients with type 2 diabetes may take medications by mouth or require insulin injections.

Over time, the kidneys of patients with diabetes may be damaged by the body's inability to maintain the proper balance of glucose. Kidney disease, one of the most serious complications of diabetes, causes at least a third of patients with type 1 diabetes to experience kidney failure within 20 to 30 years after the onset of their disease.

Waiting for a Pancreas Transplant

All kidney-pancreas transplants at Emory are performed using organs from deceased donors.

If following the kidney-pancreas transplant evaluation process it is determined that kidney-pancreas transplantation is the best treatment option for you, your name will be placed on a waiting list. The United Network for Organ Sharing (UNOS) is the national agency that regulates organ transplantation. LifeLink of Georgia facilitates organ donation for the state of Georgia. UNOS, along with LifeLink of Georgia, puts your name on a national computerized transplant waiting list and helps locate donor organs.

Once you have been listed, your dialysis unit or doctor's office will send a monthly blood sample to Emory. This sample is used to check your compatibility with any potential donor organs that become available. To remain eligible for a transplant, it is necessary to send in this blood sample every month.

Due to a critical shortage of donor organs, adults can wait for several years before a suitable kidney and pancreas become available. Often patients can wait at home during this time.

When a compatible kidney and pancreas have been found, you will be notified by a member of the transplant team. At that time, you will be given instructions about coming to the hospital for your transplant. The first call you get does not always mean the transplant will occur. The surgeon must examine the organs before giving final approval for your transplant. You will also have your blood tested against the donor to make sure you are not sensitized against this donor, a situation which would result in rejection of the kidney and pancreas.

The United Network for Organ Sharing (UNOS) provides a toll-free patient services line to help transplant candidates, recipients, and family members understand organ allocation practices and transplantation data. You may also call this number to discuss problems with your transplant center or the transplantation system in general. The toll-free patient services number is 1-888-894-6361.

Anxiety While Waiting is Normal

Helpful ways of coping with the stress of waiting for a pancreas may include:

  • Keeping up your normal daily routines as much as possible.
  • Talking with someone on your team to help sort out your feelings. This could include your transplant coordinator, social worker, or physician. While waiting for a transplant, just "checking in" with your coordinator on a regular basis allows you to get questions answered and talk about any anxiety you may be having.
  • Contacting the Georgia Transplant Foundation's Mentor Project. This program has been developed to match people who are new to the world of transplantation with people who are living with a transplant. You can get more information on the Mentor Project during your evaluation.

Pancreas Transplant Surgery

When you arrive at Emory for your transplant, your transplant coordinator will direct the check-in process. Some final testing will be done to make sure you are healthy enough for surgery. These tests may include chest X-ray, EKG, blood and urine tests, and a health history and physical exam.

Once in the operating room, you will receive general anesthesia and be put to sleep. The surgeon will make an incision in the center of your abdomen from just below your breast bone to your pubic bone. The donated kidney will be placed in the left lower part of your abdomen in a protected area. The blood vessels of the kidney will be connected to your large blood vessels nearby. The ureter (the tube that connects the kidney to the bladder) will be stitched to your bladder so that urine can flow from the kidney, through the ureter, to your bladder.

During the same operation, the donor pancreas will be transplanted. The pancreas is also placed in the lower part of your abdomen. Blood vessels are connected to supply blood flow to the pancreas. A section of the donor small intestine, called the duodenum, is removed along with the donor pancreas. This section of donor intestine is sewn onto your small intestine so that the digestive enzymes secreted from the pancreas will empty into your intestine. Once the pancreas is in place, the incision is closed using staples and a sterile dressing is placed over the incision.

After Pancreas Transplant Surgery

After surgery, you will be taken to the recovery room and then either to the transplant unit or the surgical intensive care unit. The length of your stay in the hospital for kidney-pancreas transplant typically ranges from six to 10 days.

You will likely remain on a continuous IV insulin infusion for the first several days after your kidney-pancreas transplant. While you are in the hospital, your blood sugar levels will be followed closely and your insulin adjusted as your new pancreas begins to function.

You will have several tubes and monitors for the first few days after surgery. A nasogastric tube (NG) will be placed through your nose down into your stomach. This tube helps keep your stomach empty, or "decompressed," to protect the area where the pancreas is attached to your small intestine. You will also have a foley catheter, a small tube placed into your bladder to drain and measure your urine output. A main IV line will be inserted in your neck so that labs can be drawn and the many medications and IV fluids you will receive can be administered. These tubes and IVs will be removed gradually as your recovery progresses.

Going Home

Going home after your transplant is exciting, but it can also be overwhelming. Before you go home, we will thoroughly review with you and your family what you need to do to take care of yourself and your new kidney and pancreas. Your transplant coordinator, pharmacist, social worker, and nurses will begin preparing you for discharge the day after surgery.

After discharge, you will be seen at least once a week for the first six weeks in the Outpatient Transplant Clinic. You should continue to check your blood sugar at least twice a day at home. You will need to record your blood sugar levels along with your daily weight, temperature, and blood pressure.

Some kidney-pancreas transplant recipients still require insulin injections at the time of their discharge, usually due to the side effects of the large doses of prednisone after transplant. Usually, as your dosage of prednisone is decreased, you will no longer need extra insulin.

Ureteral Stent Removal

Most transplant recipients will have a ureteral stent placed as part of their kidney transplant surgery. The urine produced by your new kidney flows to your bladder through the ureter. The ureter came with the donor kidney and was connected to your bladder with a small incision. The stent is a thin, hollow tube which is placed inside the ureter to keep it open and allow the connection to your bladder to heal.

The ureteral stent needs to stay in place for about six weeks after the transplant. By this time, healing will be complete and your stent can be removed. A urologist who works with the transplant team will remove the stent during a brief procedure called a cystoscopy.

When to Call the Transplant Team

You should call the Transplant Team if you experience any of these symptoms, or any time anything about your health changes, even if it is not related to your transplant:

  • Temperature of 100
  • Blood pressure greater than 170/100 for two readings in a row
  • Weight gain of more than three pounds in a day or five to seven pounds in a week
  • Cough, shortness of breath, sore throat, chills
  • Nausea, vomiting or stomach pain
  • Diarrhea
  • Decreased appetite
  • Blood in the urine or bowel movements
  • Painful urination
  • Increased pain, redness, or pus-like drainage at the incision
  • Pain, tenderness or swelling in the area of the new kidney
  • Feeling unusually tired
  • Persistent headache or flu-like symptoms
  • Any unexplained rash, sores, or bruising
  • Swelling of the hands, feet or ankles
  • Inability to take medications for any reason
  • Anything that concerns you about your health

For more information, please call 855-366-7989.

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