Much of what you need to know for pancreas transplant is the same information provided to individuals having a kidney transplant. This section of your handbook will provide you with information specific to pancreas transplant. Along with the other sections in your handbook, the pancreas section is designed to provide you with information you will need to have a successful pancreas transplant.
About Your Pancreas
Your pancreas is a spongy tube shaped organ about 6 inches long, behind your stomach. It is connected to the first part of your intestine called the duodenum.
Your pancreas makes juices called enzymes, and hormones called insulin. Both enzymes and hormones work to keep the body functioning right. Insulin controls the amount of sugar in the blood. Pancreatic juices help digest food.
A Pancreas transplant is done when a patient has had a history of type-1 insulin dependent diabetes. Transplant can be done in one of three ways:
- Pancreas After Kidney (PAK) Transplant
- Simultaneous Kidney Pancreas (SKP) Transplant
- Pancreas Transplant Alone (PTA)
The goal for the patient going through pancreas transplant is "insulin independence". This means that you will no longer have to take insulin, monitor your blood sugar levels, or have a restricted diet. Pancreas transplant is not just a treatment for diabetes; it is a cure.
Pancreas Transplant Evaluation
The evaluation and listing phase for a pancreas transplant is very similar to the kidney transplant evaluation (see "Evaluation" section of this handbook). Additional testing required for pancreas transplant includes:
- Angiograms if your creatinine clearance is less than 20.
- Stress Echo test if your creatinine clearance is greater than 20.
- Consultation with the Diabetic Team including the diabetic educator and an Endocrinologist.
- Gallbladder ultrasound.
The pancreas transplant surgical procedure is more complex than the kidney transplant surgical procedure. The kidney is placed "retro-peritoneal" meaning it is placed just under your belly. The pancreas is placed "intra-abdominally" meaning it is placed deeper in your belly.
The incision for the pancreas will be located on your mid-line, meaning it will run from just below your ribcage to the top of your pubic bone. It will be about 8-10 inches long.
The surgery will last approximately 3 hours. There are two different surgical ways to drain the pancreas’s digesting enzymes. One way is to connect the pancreas to your bladder. When this is done, you must drink a lot of fluid to keep the enzymes from hurting your bladder. Checking your urine monitors for signs of rejection.
The second way to drain the enzymes is to attach the pancreas to your small intestine. This is the method that is used at the Avera McKennan Transplant Institute. This method is less harmful to your bladder. Rejection will be monitored through periodic biopsies. (See "Rejection" section for more information.)
When you wake up from your pancreas transplant surgery, you will have more equipment to help you recover than you have after a kidney transplant. Some things you can expect are:
Intensive Care Unit (ICU) Some patients may go to the ICU immediately after surgery.
Nasal-Gastric (NG) Tube This is a tube that is inserted into your nose and goes to your stomach. This tube keeps pressure from building up in your stomach and helps you feel more comfortable. You will have this tube an average of 2-4 days.
Jackson-Pratt (JP) Drainage Tube This tube is inserted into your abdomen through your incision. It collects pancreatic juices following surgery. You will have this about 24 hours.
Foley Catheter This is a tube inserted into your bladder to collect urine. You can expect to have this in for 2-3 days.
Your hospital stay will be, on average, 7-9 days.
Possible Surgery Complications
As with any surgery, there are possible complications. The following are complications the transplant doctors will be watching for:
- Blood clots
- Pancreas Inflamation
- Major abdominal surgery complications
- pulmonary emboli
Monitoring for Infection and Rejection
You will follow the same guidelines for pancreas transplant that you did for kidney transplant (see "After Transplant" section of your handbook).
In addition to these guidelines, pancreas transplant patients will also monitor for rejection by:
Blood sugar levels - you will start out monitoring your blood sugar levels 4 times per day. This will gradually reduce in frequency.
Lab Values - you will have additional tests run by the lab. The team will monitor the Amylase and Lipase levels in your blood for indications of rejection.
Biopsy - you may have biopsies done on your pancreas to monitor for rejection.
Following a pancreas transplant, you will take the same medications that are used for kidney transplant (see “After Transplant” section of your handbook).
The dosage of the immunosuppressant medications will be increased immediately after surgery and will be tapered over time, just as they are with kidney transplant.
You can expect your clinic visits to be the same as the kidney transplant visits (see “After Transplant” section of the handbook). Your coordinator will provide you with your first clinic visit date before you leave the hospital.