Kidney and Pancreas Transplant

What is a kidney and pancreas transplant?

A kidney-pancreas transplant is a surgery to transplant both a kidney and a pancreas at the same time. Another name for this transplant is a simultaneous pancreas and kidney (SPK) transplant.

A simultaneous kidney-pancreas transplant is for people who have both kidney failure and Type 1 diabetes. Some people with Type 2 diabetes may be also eligible for kidney-pancreas transplantation.

Kidney failure is a relatively common complication of Type 1 diabetes, especially if diabetes is poorly managed for several years. If you have kidney failure and Type 1 diabetes, healthcare providers usually recommend a kidney-pancreas transplant so you can also regain natural insulin production and kidney function.

If your healthcare provider believes you’d benefit from a kidney-pancreas transplant, you’ll meet with a transplant team who’ll evaluate your condition and determine if you’re a good candidate. Not everyone will be a candidate for a combined transplant, even if you have both kidney failure and Type 1 diabetes.

Who’s a candidate for a combined kidney-pancreas transplant?

If your healthcare provider feels you’re about to enter kidney failure (or have kidney failure) and you also have Type 1 diabetes, they may recommend a kidney-pancreas transplant. You’ll visit a transplant center and meet a team of surgeons, a nephrologist, transplant coordinators and other healthcare professionals who determine if you’re a candidate for a transplant.

Transplant centers use different criteria to evaluate people before placing them on a transplant waiting list. Some of these factors include:

• Your overall health, including if you smoke or have a substance use disorder.
• Your medical history and if you have any health conditions like cancer or other diseases.
• Physical exam.
• Psychological exam.
• Tests to evaluate your kidney and pancreas function.
• Tests that check your heart, lungs, bladder and other organs.

How common are kidney and pancreas transplants?

About 800 to 900 kidney-pancreas transplants happen each year in the United States. Approximately 1,200 to 1,500 people are on the waiting list for a combined kidney-pancreas transplant.

Where do my new kidney and pancreas come from?

While kidney transplantation can come from both living donors and deceased (non-living) donors, a pancreas can only come from a deceased donor. In most cases, a kidney-pancreas transplant involves using deceased donor organs (ideally from the same person).

All donors are carefully screened to prevent any transmissible diseases or other complications. The donor is also carefully evaluated to make sure there’s a suitable match to your tissue and blood type.

How long will I have to wait before I receive my transplant?

It’s impossible to predict how long a wait there will be. The average wait is about 24 to 36 months. Some people might have to wait longer than others for their transplants because their blood and tissue types are less common, so it takes longer to find a compatible match.

What is the procedure for receiving a deceased donor kidney and pancreas for transplant?

If your transplant team determines you’re a good candidate for a kidney-pancreas transplant, you’re put on a transplant waiting list. Your name and blood test results go on the United Network for Organ Sharing’s (UNOS) national list.

When a deceased donor’s kidney and pancreas become available for transplantation, they’re given to the best possible match, based on blood type, tissue type, cross-match compatibility and the length of time the recipient has been waiting. Once you’re matched with a donor, the process moves fairly quickly, as you’ll need your transplant surgery within 12 hours of the organs being removed from the donor.

What happens during a kidney-pancreas transplant?

Kidney and pancreas transplantation involves placing a healthy kidney and pancreas into your body. The healthy organs can perform all the functions that the failing kidney and pancreas can’t.

You’re asleep for the entire surgery under general anesthesia. Your surgeon makes an incision in your abdomen. The kidney transplant typically happens first. Your surgeon places the donor kidney in the lower right or left side of your abdomen and connects it to nearby veins and arteries. The vein and artery of the new kidney are then attached to your vein and artery. Finally, the ureter from the new kidney will be connected to your urinary bladder to allow pee to pass out of your body. Often, your original kidneys are left in place (not removed).

Your surgeon then places your new pancreas on the lower right side of your abdomen and connects it to nearby blood vessels. Placing the pancreas in this position allows it to be easily connected to veins, arteries and your small bowel. The vein and artery of the new pancreas are attached to your vein and artery. There will be a small segment of small bowel attached to the pancreas to allow pancreatic juice (for digestion) to go back to your digestive system. Most of the time, your surgeon will not remove your old pancreas.

The new organs should start functioning within a few hours, which means your new pancreas creates insulin to regulate your blood sugar.

Most people spend between eight and 12 days in the hospital after a transplant, but some people may stay for up to 28 days (one month).

How long is a kidney-pancreas transplant?

You can expect the surgery to last between four and eight hours.

What are the benefits of a kidney-pancreas organ transplantation?

A successful kidney and pancreas transplant gives you increased strength, stamina and energy. After transplantation, you should be able to return to a more normal lifestyle and have better management of your daily living. Most people report an increase in their overall quality of life.

If you needed regular dialysis before the transplant, you’ll have more freedom because you won’t be bound to your kidney dialysis schedule. The pancreas transplant will keep your blood sugar normal, and you’ll likely no longer need insulin injections.

What are the risks of a kidney-pancreas transplant?

As two organs are transplanted, the risk of surgical complications is higher than that of a single organ transplant (such as a kidney-only transplant).

As with any organ transplant, the main problems to watch for are infection and organ rejection.

Rejection is your body’s way of not accepting the new kidney and pancreas. As your body recognizes the new organs as foreign objects, it will normally try to get rid of them or “reject” them. But immunosuppressant medications (anti-rejection medication) should prevent rejection. You’ll need to take these medications for life. Immunosuppressant medications weaken your immune system, which makes you more susceptible to more serious complications of infections or illnesses.

Additionally, your provider will want to have your blood drawn periodically to prevent rejection.

Let your provider know if you experience any of the following symptoms:

• Fever.
• Drainage of pus or fluid from the transplant site.
• Tenderness or soreness at the transplant site.
• Pain when peeing.

Other possible risks include blood clots and excessive bleeding (hemorrhage). In rare cases, the connection of the small bowel or bladder can leak and you may need another surgery to fix it.

What is the recovery like for a kidney-pancreas transplant?

You can expect to spend at least 10 days in the hospital recovering. Your healthcare team needs to monitor you and ensure that your body doesn’t reject the new organs.

You’ll take special anti-rejection medication called immunosuppressants for the rest of your life. This medication prevents your body from attacking your new organs. Take your medication exactly as your provider prescribes. Keep in mind, there are side effects to immunosuppressants like being more susceptible to infection. Ask your healthcare provider about these side effects and what you should do if you experience them.

Your provider will want to see you for periodic check-ups and tests to make sure your organs are working as they should.

How successful are kidney-pancreas transplants?

A combined kidney-pancreas transplant improves both quality of life and life expectancy. There is an 80% chance that you will not need insulin or dialysis for at least a year. There is a 70% chance that you won’t need either of those treatments for the next five years. This has a significant impact on your daily quality of life.

How long can someone live after a kidney and pancreas transplant?

According to a 2020 national survey, the survival rate after a combined kidney-pancreas transplant in the U.S. was:

• 14% after one year.
• 7% after five years.
• 1% at 10 years.

When was the first kidney-pancreas transplant?

The first kidney-pancreas transplant in the United States took place in 1966.

Are pancreas transplants performed without kidney transplants?

In some circumstances, a pancreas transplant can be performed without a kidney transplant. (It’s also possible for a person to have a kidney transplant first and have a pancreas transplant at a later date.)

The rate of pancreas transplant complications is similar to that of a kidney and pancreas transplant, but the chances of long-term success aren’t as good. However, newer drugs and better tissue-matching procedures can offer a reasonable success rate. Your transplant surgeon can determine if a pancreas transplant is needed without a kidney transplant, based on your medical condition.