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| Transplant Unit |
Frequently asked questions about combined kidney & pancreas transplantation |
This information sheet is for diabetic patients whose kidneys have failed and who are on, or about to join, the kidney transplant waiting list.
The sheet presents information about pancreas transplantation, which may be something you would like to consider.
What is a pancreas transplant?
Small clusters of cells called islets within the pancreas normally produce insulin. By transplanting a new pancreas into a diabetic patient we also transplant the islets, thus providing a new source of insulin in the body without the need for any more injections.
Why transplant a whole pancreas and not just the insulin producing cells?
Although early results of islet transplantation are promising, the long term success of islet transplantation is unproven. It remains an experimental area of transplantation. Transplantion of a whole pancreas containing islets is necessary to achieve successful and long lasting insulin production.
Is a pancreas transplant suitable for all diabetics?
No. Only type I diabetic patients, those who become diabetic in childhood. In addition it is normally restricted to patients who also need a kidney transplant.
A pancreas is transplanted at the same time as a kidney. It is more complicated than a kidney transplant and takes longer to perform. The operation itself involves connecting the blood supply of the pancreas to the vessels that take blood to and from the leg, usually the right leg. The leg normally gets much more blood than it needs and does not suffer from the operation. In addition to connecting up the blood vessels another join has to be made into a piece of bowel to drain away the digestive juices which the pancreas produces. All this is done through an incision in the abdomen.
Do I need to take any other medicines afterwards?
Yes. As with all transplants you need to take drugs called immunosuppressants. However since you will be having a kidney transplant at the same time you will be having these drugs anyway. What you won't need again is insulin.
With all transplant operations, there is a potential for problems. Pancreas transplants are no exception to this. Potential problems include rejection of the pancreas, clotting of the blood supply and inflammation of the pancreas (pancreatitis). Rejection will happen in about a third of transplants and clotting of the blood supply in 5 transplants out of 100. We are always alert to these problems and you will be given treatment to avoid them or treat them. In addition some patients, (about 4 in 10) will need a second operation to fix a problem that occurs early after the transplant. It is true to say that problems in the early days are more common if you have both a kidney and pancreas than just a kidney. However you will be carefully assessed to make sure you are fit enough to withstand the procedures before your name is placed on the waiting list.
What are the benefits of a pancreas transplant?
As well as not needing to give yourself insulin injections anymore you won't need to worry about frequent blood tests or diabetic diets. The biggest benefit is that once you have a pancreas transplant, and your insulin is controlled automatically, most of the other damage that diabetes does to you is stopped. In some cases some of the problems may improve, although it usually takes several years to see any improvement. This includes problems with nerve damage and artery disease of your feet and heart. The pancreas will also stop you damaging your new kidney in the same way your diabetes damaged your own kidneys.
A kidney transplant for a suitable diabetic patient is very successful, with 85 to 90% working one year after, and with an average life of 10 years. Results of a pancreas transplant are also good, with 70 to 80% working at a year and lasting an average of 8 years. Because of its improved success it is now the recommended treatment for patients with diabetes and kidney failure in North America. Nevertheless, occasionally it isn't successful and the pancreas may need to be removed.
How long will I be in hospital?
For a kidney transplant alone patients normally stay for about 10 days. Following a kidney and pancreas transplant the stay is longer, but usually not more than 3 weeks.
Diabetes is dangerous - it damages your kidneys, your eyes, your arteries and your nerves. Pancreas transplantation is potentially dangerous, and therefore you will be carefully looked after. Occasionally patients may even die from combined pancreas and kidney transplantation, just as they may die after kidney transplant alone - but it is uncommon (less than 5 in 100). What a successful pancreas transplant would do is allow you to reduce the damage which diabetes causes.
What happens to my old pancreas?
We do not touch your own kidney or pancreas - they are left alone. Your own pancreas continues to work producing digestive juices.
Do I need to continue on a diet?
No. You will not need to follow a diabetic diet, or a renal diet, if both your pancreas and kidney transplants are working well. We would ask that you avoid putting on a lot of weight.
You will be seen by the transplant doctors and they will assess your suitability for a combined kidney & pancreas transplant, if you would like to be considered for this.
Author : Mr Chris Watson, Consultant Transplant Surgeon at Addenbrooke's Hospital
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paul.jones@addenbrookes.nhs.uk
Updated 16/01/03 © 2003 Addenbrookes NHS Trust |
