Our Philosophy of Care
At the University of Rochester Medical Center, we believe a pancreas transplant is a lifelong commitment for you and for us. We will stay involved with you and your family through the entire transplant process. We get to know you very well and recognize that preparing for and living with a transplant will affect your lifestyle in many ways. We will help you maintain and resume many of your activities and even become involved in new ones.
We are committed to the time, effort, and resources required to make your transplant a success. Our definition of success extends far beyond the operating room. We will work with you to make your life after the transplant as successful as possible.
What Does the Pancreas Do?
The pancreas is a small (5 to 6 inches) gland that produces insulin and enzymes used for digestion. Insulin regulates the use of blood sugar throughout the body and is therefore necessary for life.
What is a Pancreas Transplant?
In a pancreas transplant, the patient’s diseased pancreas is replaced by a healthy pancreas from a donor. Usually, the healthy pancreas comes from someone who has recently died but did not have injury to the pancreas. This is called deceased donor transplantation. However, a segment of pancreas can be taken from a living organ donor who may be a family member or friend.
Because type 1 diabetes is often associated with kidney failure, a person who needs a pancreas transplant may also need a kidney transplant. Therefore, there are three types of pancreas transplants:
- Pancreas-only transplant: For people who have a kidney that works. About 85% of people who have this procedure stay insulin free one year after surgery.
- Pancreas-only transplant after a kidney transplant: For people who have already had a kidney transplant. About 70% of people who have this procedure stay insulin free one year after surgery.
- Combined kidney-pancreas transplant: For people who need both a pancreas and a kidney. About 60% of people who have this procedure stay insulin free one year after surgery.
According to the American Diabetes Association, a recent study shows that for people with at least one working kidney, survival rates of people who have a pancreas-only transplant are worse than the survival rates of people who use other treatments (such as insulin and diet) for their diabetes. Further, a pancreas transplanted along with a kidney is less likely to fail than a pancreas transplanted alone. That’s why the third type, the combination kidney-pancreas transplant, is actually the most common type of pancreas transplant, followed by the second. The first, a pancreas only transplant, is the least common of the three.
Is a Pancreas Transplant Right for You?
A pancreas transplant is normally offered only to people who have severe type 1 diabetes. Usually they are age 50 or less. The most frequent type of pancreas transplant is a combination kidney-pancreas transplant.
Your general health and suitability for major surgery are important considerations. For example, you can’t have a transplant if you have:
- Cancer in another part of your body
- Serious heart, lung, liver, kidney, blood vessel, or nerve disease that would make the operation too risky
- An active, severe infection that can’t be completely treated or cured, such as tuberculosis
- An inability to follow your doctor's instructions
Of course, all major surgery carries risks, and a transplant is no exception. The risks associated with surgery in general are:
- Reactions to anesthesia
- Problems breathing
Transplants carry additional problems, such as:
- Rejection (the body considers the transplanted organ to be a “foreign substance” and uses its natural immune system to destroy it)
- Life-long need to take medicines (called immunosuppressive drugs) that prevent rejection by suppressing the immune system, thus weakening the body's ability to fight infections
- Finding a healthy organ
All of these issues are discussed in more detail later on this site. But despite these risks, a transplant may be the best treatment option for your condition. Pancreas transplants do save lives. Consider the following:
- About 87% of the 326 people who had pancreas-only transplants in 1997 and 1998 (both type one and type two, above) survived for at least three years afterwards
- About 89% of 1,803 patients who had a combined kidney-pancreas transplant in 1997 and 1998 survived for at least three years afterwards
The Transplant Process
In addition to the information that follows, you can get a brochure about pancreas transplants at URMC. You can request the complete brochure by calling us at (585) 275-7753.
When you’re referred to us for a pancreas transplant, a five-step process will begin.
The Transplant Process - Transplant Surgery
You’ll be contacted when a pancreas (or kidney and pancreas if it’s a combined kidney-pancreas transplant) is available. If your new organ is from a living donor, both you and the donor will be in surgery at the same time. One team of surgeons will remove a section of pancreas (and a kidney, if it’s kidney-pancreas transplant) from the donor while another prepares you to receive the donated organs.
If your new organ(s) is from a person who has recently died, your surgery starts when it arrives at the hospital. The pancreas must be transplanted into the recipient within 12 to 15 hours.
A pancreas-only transplant can take from 2 to 4 hours or more; the combination kidney-pancreas transplant can take about 5 to 7 hours or more. After you’re given general anesthesia, the surgeon makes an incision in your abdomen. If you’re having a pancreas only transplant, the new pancreas can be put on your right or left side. If you’ve already had a kidney transplant, the new pancreas will be put on the side opposite the kidney. If you’re having a combined kidney-pancreas transplant, the pancreas is often placed first, on the right side; the kidney is then placed on the left. In all cases, your diseased pancreas is not removed, but left in place.
To restore blood flow to the new pancreas, it’s connected to a major artery and a major vein. The beginning of the small intestine (called the duodenum) from the donor pancreas is connected to your intestine or bladder.
If you’re also having a kidney transplant, the artery and vein of the new kidney will be connected to your own artery and vein. Your blood will then flow through the new kidney. The ureter from the new kidney will be connected to your bladder.
The Transplant Process - Recovery in the Hospital
You’ll probably stay in the hospital for about a week or two after surgery. Immediately after surgery, you’ll be taken to the Surgical Intensive Care Unit (SICU). After a day or so there, you’ll go to the Inpatient Transplant Unit where you’ll take medicines to prevent infections and rejection of your new pancreas. Your doctor will check for possible post-operative problems, such as:
- Clotting of major vessels: If the major artery and vein that supplies blood to the pancreas becomes blocked, the pancreas can fail and will have to be removed.
- Major bleeding: Sometimes (not often) small blood vessels in the new pancreas bleed and need to be tied off in a second surgery.
- Leaking from intestinal connection: If the bowel doesn’t heal together after the transplant surgery, there may be leakage and infection and a second surgery may be needed to repair this.
- Pancreatitis: This is an inflammation of the new pancreas that can prevent it from working right or cause fluid accumulation in the abdomen and/or pain.
You’ll also be prepared for your return home. You’ll be given a schedule for follow-up visits and routine blood draws, and a 24-hour phone number for emergencies or other problems. You’ll learn how to deal with the medicines you’ll be taking and their side effects, recognize rejection symptoms, plan proper diets and generally take responsibility for your recovery at home. The transplant coordinator, social worker, and psychiatrist are all available when needed. The social worker will help arrange your discharge needs, such as rehabilitation or long-term placement, chemical dependency counseling, and transportation home. You’ll also be offered a referral to a community health nurse who can help you at home.