Renal and Pancreas Transplant
Eric P. Cohen, MD
Sundaram Hariharan, MD
Barbara A. Bresnahan, MD
Brahm Vasudev, MD
Ehaab Saad, MD
Getting a Kidney-Pancreas Transplant
What is a kidney-pancreas transplant?
A simultaneous kidney-pancreas transplant (SKP) is an operation to place both a kidney and a pancreas – at the same time – into someone who has kidney failure related to type 1 diabetes.
In many cases, both transplanted organs may come from the same deceased (nonliving) donor (someone who died recently). However, it is also possible for the kidney to come from a living donor (a family member or friend) and the pancreas from a deceased (nonliving) donor.
Although in most cases, both transplanted organs come from the same deceased donor, in certain cases it is also possible for the kidney to come from a living donor (a family member or friend), and the pancreas from a deceased donor.
The procedure treats both kidney failure and diabetes because the new organs replace the function of the failed kidney and the pancreas. The first successful kidney-pancreas transplant took place in 1982 at the University of Wisconsin in Madison.
Since then, more of these operations are occurring each year, and in 2000, 914 were done at transplant centers in this country.
In 2002, 905 simultaneous kidney-pancreas transplants were done at transplant centers in the United States. In all 905 of these transplants, both organs came from deceased donors.
Who is a candidate?
Adults whose kidneys have failed because of type 1 diabetes are possible candidates for a kidney-pancreas transplant. In type 1 diabetes, the pancreas does not make enough insulin, a hormone that regulates the blood sugar level in your body. The transplanted pancreas can produce insulin and correct this type of diabetes. People with type 2 diabetes are not candidates for a combined kidney-pancreas transplant. In type 2 diabetes, the pancreas makes insulin, but the patient’s body tissues are not able to use this insulin properly. For this reason, a pancreas transplant would not help to correct type 2 diabetes. However, people with this type of diabetes can still have a kidney transplant if their own kidneys fail because of their diabetes.
Indications for Simultaneous Kidney-Pancreas (SKP) Transplantation
Usually, patients who have insulin dependent (Type 1, juvenile diabetes) diabetes whose kidneys have failed (“end stage renal disease” (ESRD)) and who require dialysis, or expect to require dialysis in the next 12 months, may be considered for SPK transplantation.
Contraindications for Simultaneous Kidney-Pancreas (SKP) Transplantation
There are certain medical situations in which a kidney-pancreas transplant is usually NOT an option:
• HIV infection
• Untreated cancer and cancer that has spread
• Severe mental health diagnoses
• Substance abuse
• Severe mental retardation
• Sever coronary artery disease and/or congestive heart failure
Is it possible to have kidney and pancreas transplants at different times?
Yes. Sometimes, a patient who has kidney failure because of type 1 diabetes may have a kidney transplant first, followed by a pancreas transplant at a later date.
How long is the wait?
The waiting time for a kidney-pancreas transplant varies, depending on your blood group and how long it takes for a suitable deceased donor to become available. According to the United Network for Organ Sharing (UNOS), the average wait for a pancreas is 300 to 400 days, while the wait for a combined kidney and pancreas is about 300 days. As of September 2003, there were 2,407 candidates listed on the national waiting list awaiting a kidney-pancreas transplant.
How successful are kidney-pancreas transplants?
At the University of Wisconsin in Madison, the second largest pancreas transplant center in the world, 85 percent of the kidney-pancreas transplants are still functioning well two years after the operation. Patient survival is more than 90 percent at two years. The national average for survival rates of kidney/pancreas transplants is 94.1 percent still functioning well one year after the operation, and 87.1 percent at three years.
The best results are usually achieved with a closely matched kidney from a living Donor (usually from a brother or a sister). Statistics show that the next best results are achieved with a kidney from a less closely matched living donor (such as a spouse or friend). The success rates are also good for combined kidney-pancreas transplants from deceased donors. The best results are usually achieved when both the pancreas and a kidney come from the same donor: a deceased donor. This is because the risk of rejection is significantly reduced. However, there have been several transplants performed using a living donor, with one kidney and a pancreas segment being donated.
What does my operation involve?
In the kidney-pancreas operation, the pancreas is placed on the right side of your lower abdomen, and the pancreatic vessels are attached to the right iliac artery and vein. The pancreas is also attached to the intestines or bladder to drain its secretions. Then, the kidney is placed in the left side of the lower abdomen, the renal vessels are attached to the left iliac vessels and the ureter is attached to the bladder. Usually, your own kidneys and pancreas are not removed.
The surgical procedure usually lasts four to six hours, and your hospital stay is typically two to four weeks. Once connected, the pancreas begins to make insulin within hours, and the blood sugar is normalized. From this point on, insulin shots are usually not required unless the body rejects the new pancreas. Studies show that the new pancreas may help slow the progression of other problems related to diabetes, such as nerve and eye damage, and decrease the chance that diabetic changes may occur in the transplanted kidney.
What should I expect after the operation?
The post-operative care of the kidney/pancreas recipient is very similar to the recipient of a kidney alone. While the recipient of a kidney transplant is not usually monitored in the intensive care unit, the recipient of a kidney/pancreas may spend a day or so there for careful monitoring of both kidney and pancreas functioning. If there are no complications such as rejection or infection, you should be able to go home in seven to ten days. Remember that you will need to take special medicines, called immunosuppressive or anti-rejection medications, following your transplant surgery to help prevent your body from rejecting your newly transplanted organ. It is necessary to take these medications exactly as the doctor prescribes for the rest of your life. In addition, you will have regularly scheduled tests as an outpatient to monitor the function of your transplanted organ and will be encouraged to maintain a healthy lifestyle through diet and exercise.
What complications may occur?
The main complications that may occur are infection and rejection. In order to prevent rejection, it is important to take your medications faithfully, exactly as ordered by your doctor. The symptoms of rejection you need to watch for may include tenderness around the grafts, decreased urine output, increase in blood glucose level, fever, abdominal pain and vomiting.
If you have any of these symptoms, speak to your transplant team right away. You will be evaluated regularly at the transplant center. Sometimes, early symptoms of rejection are hard to notice, but they can be detected in your blood work and treated. Most kidney-pancreas transplant patients will have a rejection episode during the first few months, and they will need to return to the hospital for treatment.
The medications you need to take to prevent rejection lower your body’s immune defenses, which increases your chance of getting an infection. This risk is higher right after your transplant because the doses of your medications are higher. During this time, it is important to avoid large crowds and people who are sick, especially with contagious illnesses such as colds or flu. You should wash your hands often. After a while, the doses of your medications will be reduced, and the chance of getting infections will be less.
Diet and Exercise
Transplant recipients need to be aware of the important role of a healthy diet and exercise plan in healing. Prior to your discharge from the hospital, talk to your doctor or dietitian about your goals and requirements. Since each person is different, know that you can ask for help in developing a plan that fits your needs, likes and dislikes.
Diet After a Transplant
After your transplant, you will be feeling better and looking forward to returning to your normal lifestyle. A major part of that normal lifestyle is the ability to enjoy eating again. However, some of the drugs you will be taking after your transplant affect the way your body processes food. This may cause you to eat more, causing you to gain weight.
Excessive weight gain can be harmful to your health because it increases the risk of heart disease, diabetes and high blood pressure. The following tips may help you avoid unwanted weight gain:
• Eat a balanced diet with plenty of fruits and vegetables.
• Eat a minimum amount of salt, processed foods and snacks.
• Use herbs and spices to add flavor, instead of salt.
• Watch your food intake and drink plenty of water (unless you are told to limit fluids).
• Try to eat high-fiber foods, such as raw vegetables and fruits, which make you feel full.
• Add calcium to your diet by eating calcium-rich foods, such as low-fat dairy products and green, leafy vegetables or calcium supplements.
• Eat as little fat and oil as possible.
• Read food labels so that you can be smart when food shopping.
• Become more aware of serving sizes that are listed on food labels.
• Because protein helps your build muscles and tissue, which will help you heal after surgery, eat foods high in protein, such as meat, poultry (i.e. chicken), fish, eggs, nuts (without salt) and beans.
• Select healthier condiments, such as mustard, and low-fat mayonnaise and salad dressings.
• Choose healthy cooking methods. Instead of frying, try baking, grilling, broiling or steaming foods. And instead of oil, use nonstick, fat-free spray or sauces.
• When dining out, try to eat smaller portions and avoid high-fat entrees.
• Don't drink alcohol or use any drugs that aren't prescribed by your physician, as these may harm your new organ. If you have a problem with drugs or alcohol, talk with your social worker, who can help arrange for counseling and other support services.
Exercise After a Transplant
Most people are weak after any surgery. Transplant recipients must recover from surgery, as well as the illness that caused the need for a transplant. As a result, exercise and muscle strain should be limited when you return home. Talk with your doctor about what to expect.
As you start to feel better, regular exercise will help you regain your strength. Because you may feel tired at first, you should take rest breaks during exercise. Gradually, increase the amount and type of physical activity you enjoy.