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Pancreas transplant Content Supplied by NHS Choices
Introduction

A pancreas transplant is an operation to treat diabetes by replacing the need for insulin with a healthy insulin-producing pancreas from a donor who has recently died.

The pancreas is an organ in the abdomen that produces both digestive juices and hormones, such as insulin, that help the body break down food and turn it into energy.

A pancreas transplant is sometimes recommended as a treatment for people with insulin-treated diabetes, such as type 1 diabetes, who are unable to produce their own insulin.

This page covers:

Why they're carried out

What happens

Recovery

Risks

Outlook

Why pancreas transplants are carried out

A pancreas transplant allows people with type 1 diabetes to produce insulin again. It is not a routine treatment because it carries significant risks, and treatment with insulin injections is often effective.

A pancreas transplant is usually only considered if:

  • you also have severe kidney disease - a pancreas transplant may be carried out at the same time as a kidney transplant in these cases
  • you have severe episodes of dangerously low blood sugar levels (hypoglycaemia) that occur without warning and aren't controlled with insulin

If your doctor thinks you might benefit from a pancreas transplant, you'll need to have a detailed assessment to check whether you're healthy enough to have one, before being placed on a waiting list.

Read more about who can have a pancreas transplant and being on the pancreas transplant waiting list.

What happens during a pancreas transplant

A pancreas transplant needs to be carried out as soon as possible after a donor pancreas becomes available.

The procedure is performed under general anaesthetic, where you're asleep.

A cut (incision) is made along your tummy. The donor pancreas - and donor kidney, if you're having a kidney transplant at the same time - is then placed inside, and attached to nearby blood vessels and your bowel.

The new pancreas should start producing insulin straight away. Your old damaged pancreas will be left in place and will continue to produce important digestive juices after the transplant.

Read more about how a pancreas transplant is performed.

Recovering from a pancreas transplant

You'll usually need to stay in hospital for around two or three weeks after a pancreas transplant. Most people are able to get back to their normal activities within a few months.

Your transplant team can give you advice about how long you may need to avoid certain activities during your recovery.

You'll need to have regular check-ups with your transplant team after the transplant.

You'll also need to take medications called immunosuppressants for the rest of your life. Without these medicines, your body will recognise your new pancreas as foreign and attack it - this is known as rejection.

Read more about recovering from a pancreas transplant.

Risks of a pancreas transplant

A pancreas transplant is a complex and risky procedure.

Possible complications include:

  • the immune system recognising the transplanted pancreas as foreign and attacking it (rejection)
  • blood clots forming in the blood vessels supplying the donor pancreas (thrombosis)
  • short-lived inflammation of the pancreas (pancreatitis), usually just after transplantation
  • side effects from the immunosuppressant medication, such as an increased chance of catching certain infections, developing high blood pressure, and weakened bones (osteoporosis)

Many of these problems are treatable, although sometimes it may be necessary to remove the donor pancreas.

Read more about the risks associated with a pancreas transplant.

Outlook for a pancreas transplant

The outlook for people with a pancreas transplant is usually good:

  • most people live for many years, or even decades, after a pancreas transplant - 97% will live at least a year afterwards, and almost 90% will live at least five years
  • for people who had a pancreas and kidney transplant together - around 85% of donor pancreases are still working after one year, and around 75% are still working after five years
  • for people who just had a pancreas transplant - around 65% of donor pancreases are still working after one year, and around 45% are still working after five years

The donor pancreas can be removed if it stops working, and it may be possible to put you back on the waiting list for another transplant.

Recovery

You'll usually need to stay in hospital for two to three weeks after a pancreas transplant.

Recovering in hospital

When you wake up after having a pancreas transplant, you will first be cared for in an intensive care unit (ICU) or a high dependency unit (HDU).

You'll usually be moved to a general transplant ward after 12 to 24 hours.

While in hospital, you'll be attached to various tubes, monitors and machines.

These may include:

  • a machine that delivers painkillers through a tube into your body, controlled using a handheld device
  • an oxygen mask
  • tubes that provide nutrients and fluid into a vein, or a feeding tube that goes through your nose into your stomach
  • tubes called drains that remove blood and other fluid from the operation site
  • a tube in your bladder that allows you to urinate without going to the toilet (urinary catheter)

If you've also had a kidney transplant, you may need temporary dialysis, a treatment that replicates some of the kidney's functions.

Follow-up appointments

You'll have regular follow-up appointments to monitor your progress after a pancreas transplant.

These will be quite frequent at first, but may eventually only be necessary once every few months.

During these appointments, you will have tests to check how well your pancreas and medication are working, and also check for any complications of a pancreas transplant.

Immunosuppressants

You'll need to take several medications called immunosuppressants for the rest of your life after having a pancreas transplant.

Without these medicines, your body may recognise your new pancreas as foreign and attack it. This is known as rejection.

Immunosuppressants are powerful medications that can have a range of significant side effects, such as an increased chance of getting certain infections.

While the side effects may be troublesome, you should never stop taking your immunosuppressants without medical advice. If you do, it could lead to your pancreas being rejected.

Read more about immunosuppressant side effects.

Getting back to normal

You should eventually be able to return to most of your normal activities after a pancreas transplant, although this can take a while.

  • You may need a few months off work.
  • Your stitches will need to be taken out at around three weeks.
  • You won't usually need to take insulin, restrict your diet and measure your blood sugar regularly any more.
  • You can normally start gentle exercise from six weeks, as long as you feel fit enough.
  • Light lifting is often possible after six weeks, but you shouldn't lift anything heavy, such as a shopping bag, for a few months.
  • More vigorous activities, such as contact sports, may not be recommended - at least in the short-term - as they could damage your new pancreas.

Your care team will tell you about any activities you should avoid during your recovery, and can advise you about when it's safe to start them again.

'I was a big bag of emotions – both thrilled and terrified'

Ivy Ashworth-Crees, a former diabetic, talks about how much better her life is since her double kidney and pancreas transplant.

"Over 30 years ago, I started to have diabetes and had to go on insulin injections four times a day. I also had to work very hard on my diet to make sure I didn't eat too much sweet food.

"After about 25 years I got kidney failure, and in 2003 I had to go on kidney dialysis, which was very uncomfortable.

"It was tiring having to do it four times a day, as well as having the diabetes injections four times a day. I felt like my life was on hold.

"I was on kidney dialysis for two years when they put me on the list to have a kidney transplant. The surgeon suggested that I could probably benefit from a kidney and a pancreas transplant, which meant I wouldn't be diabetic any more.

"When I got the phone call to say that I was going to Manchester for the transplant, I was absolutely hysterical. I was very emotional - thrilled and terrified.

"When I came round after the operation, I was in intensive care. I stayed there for about three or four days, then they took me to the main ward.

"The most difficult part was getting out of bed on to my feet, and starting to walk. They walked me up and down the ward for weeks until my legs got strong enough. That was very, very difficult - the pain was very bad. But it's been worth it.

"The doctor asked me to try to reduce my weight, so I joined the gym. I enjoy swimming and I think it's helping me to keep a bit more active. The only problem is that I can't walk too far.

"It's very, very important that I take the immunosuppressant drugs. If I don't take them, my body may reject the kidney and pancreas. I have to take them for the rest of my life.

"My life's changed such a lot. I now take it for granted that I can eat what I want, including chocolates!

"I'm back at work, I don't have an injection after my meals, I don't have to rush home for dialysis, and my kidneys and pancreas are working well.

"I feel blessed that I've been through this operation and it's worked very well."

Whyitisused

As donor pancreases are scarce, you'll need to be assessed carefully to determine whether a pancreas transplant is suitable for you and that you could benefit from one.

When pancreas transplants are considered

A pancreas transplant is usually only considered in a small number of cases of people with type 1 diabetes.

There are around a million people in the UK with type 1 diabetes, but only about 200 get a pancreas transplant each year.

Type 1 diabetes occurs when the immune system destroys the cells (islets) in the pancreas that produce a hormone called insulin.

It can often be controlled with insulin injections, so the risks of a pancreas transplant outweigh the benefits in many cases.

However, a transplant may be considered if:

  • you also have severe kidney disease, whether it's caused by diabetes or not - a pancreas transplant may be carried out alongside a kidney transplant in these cases
  • you have severe episodes of a dangerously low blood sugar level (hypoglycaemia) that occur without warning, in spite of good insulin control

If a healthy pancreas is transplanted into the body, it should start producing insulin, relieving any diabetes symptoms and replacing treatment with insulin injections.

Assessment for a pancreas transplant

A detailed assessment at a transplant centre is needed to find out more about your health, and check whether there are any underlying problems that could affect your suitability for a pancreas transplant.

This will usually involve having several tests, such as:

You'll also have the opportunity during your assessment to meet the transplant team and find out more about the procedure.

You may find it useful to write down a list of questions you would like to ask the transplant team before your visit.

Who might not be suitable for a pancreas transplant

Unfortunately, not everyone who thinks they would benefit from a pancreas transplant will be suitable for one.

This is because the operation places a major strain on the body, and may mean the risks outweigh the potential benefits.

For example, you may be considered unsuitable for a pancreas transplant if you:

  • have severe coronary heart disease
  • have recently had a heart attack
  • have incurable cancer
  • have a serious mental health or behavioural condition that means you would be unlikely to be able to correctly take the medication needed after a pancreas transplant
  • are generally in poor health and are unlikely to withstand the strain of surgery and the ongoing treatment that follows it
  • are obese - you may need to lose weight before a transplant is considered
  • drink alcohol excessively or abuse drugs - you may need to stop before a transplant is considered

Age isn't a factor in determining whether a pancreas transplant is suitable, although the procedure is rarely performed in older people because they often have other health problems that mean a transplant is too risky.

Decision to recommend a transplant

The final decision about whether you are suitable for a pancreas transplant is a joint decision made by the transplant team.

You may be informed about the decision before leaving the transplant centre. But if your case is not straightforward, it may be several weeks before you're told the decision.

The transplant team may decide you are:

  • suitable for a transplant and ready to be placed on a waiting list - read more about being on the pancreas transplant waiting list
  • suitable for a transplant, but your condition doesn't require a transplant - you'll usually be monitored in case your condition gets worse
  • unsuitable for a transplant - the reasons will be explained in detail by your transplant team

In some cases further tests are necessary to make a final decision, or you may be referred to a different transplant centre for a second opinion.

Preparation

Once you're assessed as being suitable for a pancreas transplant, you have to join the national waiting list. It's not possible to have one straight away because of the lack of available pancreases.

It may be several months, or possibly years, before a suitable donor pancreas becomes available.

In the UK, half of the people waiting for a pancreas transplant will have had one by around 13 months.

You will usually be able to stay at home until a pancreas becomes available.

The transplant centre can offer support, guidance and information while you wait for a suitable donor to be found.

They will be fully aware that many people find this a frustrating and frightening experience.

Waiting for a suitable donor

While waiting for a donated pancreas to become available, it's important to stay as healthy as possible by:

The transplant centre will need to be able to contact you at short notice, so you should inform staff if your contact details change.

You should also let staff know if your health changes - for example, if you develop an infection.

Prepare an overnight bag and make arrangements with your friends, family and employer so you can go to the transplant centre as soon as a donor pancreas becomes available.

Coping with being on the waiting list

Living with severe diabetes can be strenuous enough - the added anxiety of waiting for a pancreas to become available can make the situation even more difficult.

This can have an effect on both your physical and mental health.

Contact your GP or the transplant centre for advice if you're struggling to cope emotionally with the demands of waiting for a transplant.

You may also find it useful to contact a support group, such as Diabetes UK or Diabetes.co.uk, or a local kidney patients association if you're also waiting for a kidney transplant.

Getting the call

When a suitable donor pancreas is found, the transplant centre will contact you and ask you to go to the centre.

When you hear from the transplant centre:

  • do not eat or drink anything (unless your blood sugar is very low)
  • take all current medicines with you
  • take a bag of clothes and essentials for your hospital stay

At the transplant centre, you'll be reassessed quickly to make sure no new medical conditions have developed.

When the medical team has confirmed that you and the donor pancreas are suitable, you will be given a general anaesthetic.

The procedure must be carried out as quickly as possible to have the best chance of success.

Read more about what happens during a pancreas transplant.

Transplant centres

Pancreas transplants are carried out at specialist transplant centres.

UK transplant centres that perform pancreas transplants are located in:

The Transplant

Pancreas transplants are carried out under general anaesthetic. This means you'll be asleep and won't feel anything during the procedure.

  • A cut (incision) will be made in your tummy (abdomen), from just below your breastbone to below your bellybutton.
  • The donor pancreas is usually placed in the right side of your tummy and is connected to the blood vessels that carry blood down to your leg.
  • A small portion of the donor's small intestine will be attached either to your small intestine or your bladder to allow digestive juices to drain from the donor pancreas.
  • If you're having a combined pancreas and kidney transplant, the kidney will be placed low down on the left side of your tummy.
  • The old pancreas won't be removed as it will continue to produce digestive juices while the donor pancreas produces insulin.

A pancreas transplant operation can take four to five hours to complete.

If you also need a kidney transplant at the same time, the procedure can take around six to eight hours.

Your new pancreas should start to produce insulin straight away.

Islet transplantation

A small number of people with type 1 diabetes may have a slightly different procedure, where only the cells that produce insulin (islet cells) are transplanted from a donor pancreas into the liver.

This is called islet transplantation, and it's usually carried out under local anaesthetic, which means you're awake but the area being operated on is numbed.

A thin, flexible tube (catheter) is inserted through your tummy and liver, into the vein that supplies the liver with blood. The donor islet cells are then injected into it.

If the procedure is successful, the donor cells will start making insulin. This can help people who experience severe episodes of a dangerously low blood sugar level (hypoglycaemia) that occur without warning.

Insulin treatment is often still needed after the operation, but the episodes of hypoglycaemia should be easier to control.

As with a conventional pancreas transplant, medication to suppress the immune system will need to be taken.

For more information, see the National Institute for Health and Care Excellence (NICE) guidance on allogeneic pancreatic islet cell transplantation for type 1 diabetes mellitus.

After the operation

Once the transplant is complete, you'll usually be moved to an intensive care unit (ICU) or a high dependency unit (HDU).

You will be very closely looked after, and various tubes and machines that help monitor your health and support the functions of your body will be attached to you.

Read more about recovering from a pancreas transplant.

Riskspage

A pancreas transplant is a major operation. As with all types of surgery, there is a risk of complications.

Some complications can occur soon after the procedure, while others may develop months, or even years, later.

Some of the main risks associated with a pancreas transplant are described below.

Rejection

One of the most common complications of a pancreas transplant is rejection of the donor pancreas. This is where the immune system recognises the transplanted pancreas as foreign and attacks it.

Rejection usually occurs in the days, weeks or months after the transplant, although it can sometimes happen years later.

Immunosuppressant medication can reduce the risk of this happening, but can't always prevent it completely.

Symptoms of rejection can include:

  • pain and swelling in your tummy
  • a high temperature (fever)
  • being sick
  • chills and aches
  • extreme tiredness (fatigue)
  • puffy, swollen ankles
  • shortness of breath

Contact your GP or transplant team as soon as possible if you have these symptoms. Rejection can usually be treated by increasing your dose of immunosuppressant medication.

Immunosuppressant side effects

The immunosuppressant medications you need to take to prevent rejection can have a number of significant side effects.

These can include:

Speak to your transplant team if you experience any troublesome side effects. Don't stop taking your medication without getting medical advice first.

Infections

Immunosuppressant medication will weaken your immune system and make you more vulnerable to infection.

While taking the medication, it's a good idea to:

  • report any possible symptoms of an infection to your GP or transplant team immediately - things to look out for include a high temperature (fever), aching muscles, diarrhoea or headaches
  • ensure your vaccinations are up-to-date - speak to your GP or transplant team for advice about any additional vaccines you might need, as some aren't safe if you're taking immunosuppressant medicines
  • avoid close contact with anyone who has an infection - even if it's an infection to which you were previously immune, such as chickenpox

To help prevent infection, you may be given antibiotics, antifungal medicine or antiviral medication to take for the first few weeks or months after your transplant.

Blood clots

Blood clots can sometimes form in the blood vessels that supply the new pancreas, which can stop it working properly.

The risk of this happening is highest in the days after the operation, so you will be closely monitored in hospital to check for any signs of a blood clot.

You'll also be given blood-thinning medication to reduce the chances of a clot forming.

If a blood clot does develop in the new pancreas, you'll usually need another operation to remove it.

Blood clots can also form in other blood vessels after surgery, such as those in your legs (deep vein thrombosis) or supplying your lungs (pulmonary embolism), but taking blood-thinning medication should help prevent this.

Pancreatitis

Pancreatitis is swelling (inflammation) of the pancreas, and is common in the first few days after surgery.

It can occur as a result of storing the donor pancreas on ice in preparation for the transplant.

Symptoms of pancreatitis include:

  • a dull pain in your tummy
  • feeling sick
  • vomiting

Pancreatitis should pass within a few days. However, sometimes tubes may need to be placed in your tummy to drain any excess fluid off the donor pancreas, and in a few cases it may be necessary to remove it.

 
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