Pancreas Transplant

A pancreas transplant is a surgery to replace a pancreas that no longer works with a healthy donated pancreas. Nearly all donated pancreases come from deceased donors.

To get a pancreas transplant, you must have severe, long-term Type 1 diabetes (T1D) that doesn’t respond to other treatments. Healthcare providers may also consider you for a transplant if you have Type 2 diabetes (T2D) and meet certain criteria.

The transplant can reduce your risk of worsening diabetes complications. It can also end your need for:

• Daily blood sugar monitoring
• Insulin injections
• Food restrictions

Many candidates for a pancreas transplant also have kidney failure due to diabetes. In these situations, your provider may recommend a combined kidney and pancreas transplant.

Each year, healthcare providers perform about 1,000 pancreas transplants. They’re more common as part of a combined kidney and pancreas transplant.

What are the benefits and risks?

A successful pancreas transplant can help:

• Control blood sugar: Most people who receive a pancreas no longer need insulin injections or daily blood sugar monitoring. You’re also less likely to have dangerously low blood sugar levels. And there are fewer restrictions on what you can eat and drink.
• Slow down diabetes damage: A transplant won’t cure diabetes. But it can slow damage that diabetes causes to your kidneys, blood vessels, eyes and nerves.
• Improve energy levels: Many people report increased energy levels.

Most people are able to have biological children after the procedure. But it’s a good idea to wait at least a year before you try. You may need to adjust your medications before getting pregnant.

Pancreas transplantation is a complex procedure. Possible risks and complications include:

• Blood clots
• Bleeding
• Fluid leakage between your new pancreas and where it attaches to your small intestine
• Infection
• Organ failure
• Organ rejection
• Pancreas inflammation or swelling (pancreatitis)

You must also take immunosuppressants (anti-rejection medicines) for the rest of your life after a pancreas transplant. Immunosuppressants help prevent organ rejection. But they also come with some risks. Your provider will explain the risks and tell you what signs to look for.

How should I prepare for a pancreas transplant?

If your healthcare provider recommends a pancreas transplant, you must go through a lot of tests. You’ll need:

• A physical exam
• Blood tests and pee tests to make sure you’re healthy enough for surgery
• Tests to make sure your heart is healthy enough for surgery, including an electrocardiogram, echocardiogram or cardiac catheterization
• Cancer screenings
• Immune system tests, which help your transplant team match you with a compatible donor
• Imaging tests
• A mental evaluation to make sure you understand the procedure and its risks

Other eligibility criteria include:

• You have low blood sugar episodes and don’t notice any symptoms (hypoglycemia unawareness)
• You have proteinuria and pass more than 500 grams of protein in your pee each day
• You’re between 18 and 60 years old
• You have a life expectancy of at least 5 years
• You have family members or close friends who can help take care of you as you recover

If providers believe you’re an eligible candidate, they’ll put you on a national waiting list. The pancreas transplant waiting list is long. You may be on the list for months or even years before a matching pancreas is available. Providers will give you a better idea of what to expect.

What should I do while I wait?

Your care team will coach you on ways to stay healthy while you wait for surgery. For example, it’s important to:

• Attend all of your medical appointments.
• Avoid smoking and other tobacco products.
• Get regular physical activity, if you’re able.
• Cut back on alcohol.
• Report any health changes to your care team.
• Take medications exactly as prescribed.

Surgery happens quickly after a donor pancreas becomes available. As you wait, it’s also a good idea to:

• Make sure your transplant team can contact you at all times.
• Pack a hospital bag so you’re ready to go on short notice.
• Tell family, friends and your employer about your situation so they can prepare to support you.

What happens during the procedure?

A pancreas transplant is a major surgery. You’ll be asleep under general anesthesia the entire time. You won’t feel any pain during the procedure. Once you’re asleep, your transplant team will:

1. Shave the surgical area, if necessary, and sanitize your skin with antiseptic to kill bacteria.
2. Insert tubes to deliver medications and extra fluid. They’ll also insert a urinary catheter to drain pee.
3. Use a sharp, sterile tool (scalpel) to make a cut (incision) down the middle of your belly. Sometimes, the surgeon can perform the surgery through small incisions using a surgical robot that they control.
4. Place the donated pancreas inside of your abdomen.
5. Attach the donated pancreas to blood vessels in your abdomen and your small intestine.
6. Place a small silicone drainage tube near the pancreas to drain fluids.
7. Close the incisions with stitches or surgical staples.
8. Cover the surgical site with bandages.

Your care team leaves your original pancreas in place. They do this so it can still make digestive juices. Removing it would also take extra time and add risk without much benefit. After a successful transplant, your new pancreas should start making insulin right away.

How long does it take?

A pancreas transplant takes about three to five hours. It takes about four to seven hours if you need kidney and pancreas transplants at the same time.

What happens after?

After the pancreas transplant is complete, providers will move you to a bed in the hospital and monitor you for:

• Any medical issues
• Surgery complications
• Organ rejection
• Anesthesia recovery

You’ll also receive:

• Fluids, and eventually food
• Oxygen
• Pain medications
• Medications that suppress your immune system, which you must take for the rest of your life

Most people stay in the hospital for one to two weeks after a pancreas transplant. But your stay may be longer or shorter.

What is the typical recovery time after a pancreas transplant?

It takes a while to fully recover after a pancreas transplant. Your progress will come in stages over many months. During this time, you’ll:

• Get your stitches or staples out after about three weeks.
• Have regular follow-up appointments and tests to ensure the procedure was successful.
• Start gentle physical activity, with more intensity after about six weeks.

For most people, full recovery takes about six months. But it’s important to remember that your body is unique. Your recovery time after the transplant may be different. It’s important to follow your healthcare provider’s instructions. This helps ensure you’ll recover as quickly as possible.

When can I go back to work/school?

It’s a good idea to take a few months off work or school. If you have a physically demanding job, you may need to take more time off.

What is the success rate?

The pancreas transplant success rate is very good. Many people report a better quality of life. People can live for years or even decades after surgery. And if a transplanted pancreas stops working, a surgeon can sometimes remove and replace it.

What is the survival rate?

The survival rate after a pancreas transplant is very good. About 9 out of every 10 people who receive a donor pancreas are still alive five years after the procedure.

When should I call my healthcare provider?

Your transplant team will give you specific instructions about follow-up care. But you should get medical attention as soon as possible if you have any signs of organ rejection or infection. These include:

• Aches, including headaches
• Chills
• Dizziness
• A fever higher than 100.4 degrees Fahrenheit (38 degrees Celsius)
• Peeing less than usual
• Nausea and vomiting
• Pain or tenderness near your pancreas
• Swelling or sudden weight gain