Cleveland Clinic's Pancreas Transplant Center is comprised of many of the nation’s leading specialists in the field. This is one of the many reasons why the center is consistently ranked among the best in the nation. The Center’s Pancreas transplant program is approaching the 20 year mark and has completed more than 300 pancreas transplants. Although this may seem to be a modest number, it denotes a substantial amount of experience given the relative rarity of the procedure among national institutions. In 2012, a total of 14 pancreas transplants were performed, including 11 kidney/pancreas transplants.
Cleveland Clinic's pancreas transplant program is an essential component of a broad medical and surgical strategy to manage all patients with Type 1 Diabetes with the therapy most appropriate to that patient.
Cleveland Clinic's pancreas transplant program is a member of the Ohio Solid Organ Transplantation Consortium (OSOTC) and the United Network for Organ Sharing (UNOS), meeting all their requirements for pancreas transplantation.
If you or a loved one would like a second opinion from a top specialist at Cleveland Clinic, but may be disabled or find it too difficult to travel, we offer MyConsult. The MyConsult program is an online medical second opinion that connects you to our physician experts who will review your medical records and diagnostic tests to assess your suitability for transplant.
Contact our Pre-Transplant Office at 216.444.6996 or 1.800.223.2273 ext. 46996
Patients must meet certain basic criteria in order to be considered a potential transplant candidate. These criteria are different depending upon the type of organ(s) needed. These basic criteria are just the initial indicators. All patients must be fully evaluated by the transplant team to determine if transplantation is the best treatment option.
Pancreas transplants are most commonly performed in patients with Type 1 diabetes although the procedure can be conducted in selected patients with Type 2 diabetes. In Type 1 diabetes, the body’s immune system, for reasons as yet unknown, attacks and destroys beta cells in the pancreas. These cells produce insulin, a vital molecule that ferries glucose to cells throughout the body. Glucose is the fuel that energizes cells.
A pancreas transplant is not a first-line treatment. The vast majority of Type 1 diabetics manage their glucose levels though a disciplined regimen of glucose monitoring and insulin injections.
Patients that have Type 1 Diabetes and chronic kidney disease may be eligible for a combined kidney-pancreas transplant.
Relative Contraindications to Pancreas Transplant:
There may be times when transplantation is not the best treatment option for patients. Patients will be considered on an individual basis to determine whether the benefits of transplantation will outweigh the risks.
If you have any questions regarding whether you or one of your patients is a potential transplant candidate, please contact our pre-transplant office at 216.444.6996 or 800.223.2273 ext. 46996.
Welcome to the Pancreas Transplant Program
Cleveland Clinic has designated facilities and support services to assist patients and their families throughout the entire transplant process. Transplant patients at Cleveland Clinic receive the highest-quality medical and nursing care.
The transplant process begins with the patient’s referral to the pancreas transplant program. Patients may be referred by their endocrinologist, nephrologist or dialysis unit, or they may contact the pre-transplant office themselves.
Contact the pre-transplant office to begin the referral process at 216.444.6996 or 800.223.2273 ext. 46996. Patient referrals can also be faxed to the pancreas transplant program at 216.445.8141.
Request a Physician Referral Guide.
Our secure online service, DrConnect, provides referring physicians access to patient’s treatment progress with streamlined communication from Cleveland Clinic physicians to your office, allowing continued participation in the ongoing care of patients. With the best possible treatment plans and coordinated care, our team approach benefits both the patient and the referring physician.
Patients will complete a medical interview over the phone with a member of the pre-transplant department staff.
A letter will be sent to the patient and referring physician indicating the routine health maintenance testing necessary prior to beginning the evaluation process. The most efficient way to progress through the evaluation is to have this testing completed prior to the initial evaluation appointments. Testing completed within the past year is acceptable (PAP test & colonoscopy may be longer depending upon results/recommendations).
- PAP test – all females age 18 and older
- Mammogram – all females age 40 and older
- Colonoscopy – all patients age 50 and older
- Cardiac Stress Test – all patients age 40 and older
- Chest X-Ray – all patients
- Dental Clearance – if required by insurance
- Nutritional Evaluation – all patients on dialysis (a form will be sent to the patient)
Patients will be scheduled to see the transplant team to assess their transplant candidacy. The evaluation will consist of:
- Medical Evaluation
- Surgical Evaluation
- Psychosocial Evaluation
- Transplant Education
- Financial Evaluation
- Lab work
Based upon the physicians’ findings during the evaluation appointments, additional testing and consults may be needed. Once the evaluation is complete, the patient’s chart will be reviewed by the physicians and then the patient will be presented at the selection committee. The selection committee may approve the patient for listing, require additional information prior to making a decision, or determine that the patient is not a candidate for transplantation. The patient, referring physician, and dialysis unit (if applicable) will receive letters notifying of the committee’s decision.
Once a patient has been approved for transplant listing, OSOTC approval will be obtained. Insurance authorization will also be obtained if needed prior to being placed on the national transplant waiting list.
Waiting for Transplant:
Once patients have been placed on the transplant waiting list, it is important that the pancreas transplant program be notified of any changes in the patient’s condition such as:
- Changes in cardiac (heart) or pulmonary (lung) status
- Active infections
- New medical diagnoses
- Surgeries and procedures
- Blood transfusions
- Addition of anticoagulant medications (blood thinners)
It is also important for the transplant program to receive any updated testing that has been performed on the patient, such as stress tests, cardiac catheterization, carotid ultrasound, CT scans, etc. These results should be faxed to the transplant program at 216.445.8141.
It is very important that patients waiting for transplant contact our office with any changes in their address or phone number. Patients must also contact our Financial Coordinator at 216.445.9754 with any changes in their insurance coverage.
A Team Approach
The Pancreas Transplant Team at Cleveland Clinic is specially trained in meeting the needs of pancreas and kidney-pancreas transplant patients. The team is committed to providing comprehensive care in a compassionate setting.
The Pancreas Transplant Team members include:
- Transplant surgeons
- Transplant endocrinologists
- Transplant nephrologists
- Transplant coordinators
- Transplant fellows and residents
- Social Workers
- Transplant Program Assistants
- Financial counselors
- Transplant Psychiatrist
- Transplant Bioethics
- Registered nurses
- Nursing assistants
Additional consultants may also include:
- Vascular Medicine or Surgery
- Infectious Disease
The following Cleveland Clinic Transplant Center doctors and staff specialize in Pancreas Transplant:
Pancreas Transplant Program Leadership
Pancreas Transplant Program Surgeons
Pancreas Transplant Program Physicians
Pancreas Transplant Program Team Members
- Valerie Keenan, RN, BSN, CCTC
- Ragina Bass, RN
- Melissa Drummond-Young, RN
- Beverly Alt, RN, CPTC
- Eva Davis, RN
Procurement Transplant Coordinators:
- Cynthia Anderson, RN, CCTC
- Casey Billington, RN, CCTN
- Megan Begala, RN, BSN
- Margaret Kay Burr, RN, MSN
- Natalie Keyerleber, RN, BSN
- Shawn Paschal, RN, MSN, CCTC
- Elaine Beaver, RN, BSN, CCTC
- Tracy Evans-Walker, RN, MSN, CNP, CCTC
- Sherry Levy, RN, MSN, CNP
- Trudy Aquilina, MSW, LISW-S
- Cheryl Gillespie, MSW, LISW-S
- Beth Piotrowicz, MSW, LISW-S
Department Coordinators/Transplant Program Assistants:
- Melissa Nalepka - Pre-Transplant
- Monica Young - Pre-Transplant
- Jacqueline Prather - Pre-Transplant
- Dragana Komso - Post-Transplant
- Shoneice Barton - Pre-Transplant
- Beverly Suber - Post-Transplant
Clinical Support Staff:
- Vanessa Walter, LPN
- Annette Restifo, MA
Where does my new organ come from?
Organs for pancreas transplant come from deceased donors. Patients needing a kidney-pancreas transplant will usually get both organs from the same deceased donor. In some circumstances, however, patients needing a kidney-pancreas transplant may get a living donor kidney transplant followed by a deceased donor pancreas transplant.
Deceased Donor Pancreas Transplant:
A deceased donor is an individual who has recently passed away of causes not affecting the organ intended for transplant. Deceased donor organs usually come from people who have decided to donate their organs before death by signing organ donor cards. Permission for donation also may be given by the deceased person’s family at the time of death.
A deceased donor pancreas transplant occurs when a pancreas is taken from a deceased donor and is surgically transplanted into the body of a recipient whose natural pancreas is diseased or not functioning properly.
Types of deceased donor organs
There are several different types of deceased donor organs. These names are used to describe certain anatomic, biological, and social features of the donor organs. You may decide not to receive any or all of these organs, and you may change your mind at any time.
- Standard Criteria Donors (SCD): These organs are from donors under age 50 and do not meet any of the criteria below that are assigned to Expanded Criteria Donors.
- Expanded Criteria Donors (ECD): These organs come from donors over age 60 or age 50-59 that also have at least two of the following criteria - history of high blood pressure, the donor passed away from a CVA (stroke) or had a creatinine higher than the normal laboratory value (1.5 mg/dl). About 15-20% of the donors in the United States are Expanded Criteria.
- Donation after Cardiac Death (DCD): These donors do not meet the standard criteria for brain death. Their hearts stopped before the organs were removed. Donation after Cardiac Death occurs when continuing medical care is futile, and the donor patient is to be removed from all medical life-sustaining measures/supports.
- Donors with High-Risk Social Behavior: These donors are individuals who at some point in their life practiced high-risk behavior for sexually transmitted disease, drug use, or were incarcerated. All of these donors are tested for transmissible disease at the time of organ recovery. You will be informed of the high-risk behavior.
All of these organs supply suitable organs for transplant, and all are expected to provide good outcomes with good organ function. However, the outcomes may be 5-10% less than that achieved with Standard Criteria organs.
Throughout the entire transplantation process, Cleveland Clinic's transplant team ensures that you receive the best possible care. Team members are there each step of the way.
Your length of stay and recovery in the hospital will depend on a few factors including: type of transplant procedure, your body's acceptance of the new organ and your overall health. Remember, each patient has a different rate of recovery. You will be discharged only after your Transplant Team has determined that you have regained your strength and your health is stable.
Transplant team members are available after patients have returned home to provide additional information and answer questions. The team also can help with follow-up care, including routine blood testing, medication evaluation and adaptation, and visits to ensure that patients are doing well. Your transplant team will give you instructions on how and when to contact the post-transplant office following your discharge.
Taking Care of Yourself
Soon after surgery and during your stay in the hospital, your Transplant Team will teach you more about taking your new medicines. You will learn when to take your medicines, how to take them, what happens if you miss a dose, and what side effects the medicines might cause.
A daily record of your health is kept during your stay at the hospital, and you will need to continue monitoring your health when you go home. You will need to record your daily temperature, blood pressure, and weight, blood glucose levels, fluid intake and urine output. To ensure that your pancreas is functioning well, you will need to monitor these items for at least six weeks after the transplant surgery.
When will I be able to go home?
Our goal is to help you feel comfortable and confident about taking care of yourself before you go home. Before going home, you will need to be able to:
- Follow your medicine schedule correctly without assistance
- Take your temperature and blood pressure
- Keep track of and record your fluid intake and urine output
- Know whom to call for an emergency appointment
- Know what problems should be reported to the transplant coordinator
The Transplant Team will be monitoring your health closely after the transplant and during your follow up appointments. Therefore, is it very important to keep your scheduled lab and follow-up appointments.
How should I take care of myself once I go home?
Once you are discharged home, you will need to continue recording your daily temperature, blood pressure, weight, blood glucose levels, fluid intake and urinary output in a notebook. It is also very important to keep your list of medications updated.
Remember to keep the records in your notebook for at least six weeks, or longer if you have complications. The Transplant Team will let you know when it is okay to stop recording this information. Remember to always bring your post-transplant notebook and medicines to each Transplant Clinic visit.
What will I need before I go home?
It is important to make sure you have each of these before you go home:
- Blood pressure cuff
- Medication organizer
- Blood glucose monitor
To decrease the chance of infection, you must avoid people with colds or flu for at least three months. By avoiding illness now, you will be able to return to an active life within a few months.
Tips for a Healthy Transplant Recovery
- Take all your medicines exactly as prescribed
- Keep all of your scheduled appointments with the Transplant Team
- Call the Transplant Team if you have any questions or concerns
- Have your blood drawn promptly, as recommended by the Transplant Team
- Follow your recommended dietary plan
- Follow your recommended fluid intake
- Follow your recommend exercise plan
- Avoid being around anyone who has an infection
Call the Transplant Team if you experience any of the following:
- Fever over 100°F (38°C)
- Flu-like symptoms such as chills, aches, headaches, dizziness, nausea or vomiting
- An increase in blood glucose levels
- New pain or tenderness around the transplant
- Fluid retention (swelling)
- Sudden weight gain greater than four pounds within a 24-hour period.
- Significant decrease in urine output
What You Need to Know about Pancreas Transplant Rejection
What is transplant rejection?
One of the most common complications following a transplant is rejection. Rejection is your body’s way of not accepting the new pancreas. Although rejection is most common in the first six months after surgery, it can occur at any time.
Fortunately, the Transplant Team can usually recognize a rejection episode before it causes any major or irreversible damage. It is very important for you to continuously take your medications as prescribed and have your blood work drawn as scheduled.
What are the warning signs of possible rejection?
It is vital for you to be aware of the possible signs of rejection. If you think you are experiencing any of these symptoms, contact the Transplant Team immediately:
- Fever over 100°F (38°C)
- Flu-like symptoms: chills, aches, headache, dizziness, nausea and/or vomiting
- An increase in blood glucose levels
- New pain or tenderness around the kidney
- Fluid retention (swelling)
- Sudden weight gain greater than two to four pounds within a 24-hour period
- Significant decrease in urine output
How is rejection identified?
The Transplant Team will be able to determine if your body is rejecting your transplanted organ(s) by completing routine tests of pancreas function. If the Team thinks you may be experiencing any problems with your new kidney, the following tests may be completed:
- Repeated blood work
- Pancreas biopsy
What is a pancreas biopsy?
- A pancreas biopsy is a procedure in which a small sample of kidney tissue is removed and tested.
- A pancreas biopsy is usually performed on an outpatient basis.
- In order to take a biopsy, or a small sample of tissue, the skin above your pancreas is numbed to allow a small needle to pass directly through to your pancreas. Ultrasound is used to determine the appropriate location to biopsy.
- Once complete, a microscope is used to examine the sample of tissue and establish a diagnosis.
- The actual biopsy generally takes between 20 to 30 minutes.
- You will be required to lie flat for two hours following the procedure to prevent bleeding.
How is rejection treated?
If rejection develops, your physician may prescribe medications to treat rejection and prevent continued complications. In order to control the rejection, you may need to be admitted to the hospital, or you may receive care in the outpatient setting.
Will rejection treatment cause side effects?
The medications used to treat a pancreas rejection episode are strong drugs. The first few doses may cause the following side effects:
- Fever, chills
- Nausea, vomiting
- General flu-like symptoms
To help control these symptoms, you may receive a pre-medication of acetaminophen (Tylenol) and diphenhydramine hydrochloride (Benadryl) before each dose.