Pancreas Transplant
Introduction
The Renal and Pancreas Transplant Division offers the option of pancreas transplantation to patients who suffer from insulin dependent, type I diabetes mellitus. At the present time, pancreas transplantation is performed only if a diabetic patient also suffers from kidney failure. The Renal and Pancreas Transplant Division offers two programs.
Pancreas After Kidney (PAK) transplantation allows patients to receive a kidney transplant as their
first choice of therapy if a suitable living kidney donor is available.
This process may be preferable given the high long-term success rate of
living kidney transplantation and the relatively long wait for a cadaveric
kidney. Patients are then offered the option of pancreas transplantation
after successful kidney transplantation.
If a patient has already undergone kidney transplantation, either through
living or cadaveric donation, he/she can be evaluated for PAK.
Simultaneous Pancreas/Kidney (SPK) transplantation may be the procedure of choice in the event that the patient does not have a living kidney donor available.
As per our protocol and policy, the following criteria have been established for recipient selection.
Patients must:
- Have type I (juvenile) diabetes as the underlying disease
- Have evidence of kidney failure
- Be less than 50 years old
- Have had minimal abdominal surgery
- Be free of advanced secondary complications of diabetes, such as blindness, amputation, or severe vascular disease
Patients are eligible before beginning dialysis or while on hemo or peritoneal dialysis.
Proposed Benefits of PAK or SPK Transplantation
- Kidney transplantation will eliminate the need for dialysis
- Pancreas transplantation will control the blood sugar in the recipient
- Patients will have no need for insulin following a successful PAK or SPK transplant
- Patients will have no dietary restrictions
- A transplanted pancreas can delay, prevent, or in some cases, improve the secondary complications of diabetes
- Patients will experience a significant improvement in their quality of life
All potential recipients will first undergo the standard pre-transplant medical evaluation. Once it is determined that the patient may be a suitable pancreas transplant candidate, the patient will be referred to the Director of Transplant Surgery for further evaluation. Additional testing may be required at this point.
If a voluntary, suitable living kidney donor is identified, then an appropriate donor evaluation will be performed. In this instance, the patient would then undergo kidney transplantation first and PAK transplantation afterwards. All potential pancreas candidates will be referred to the Director of Transplant Surgery for evaluation for either SPK or PAK.
When the entire evaluation and testing process is complete, a determination will be made whether to place the patient on the SPK waiting list or the cadaveric kidney waiting list, or to perform a living kidney donor transplantation followed by PAK transplantation, if the patient is eligible. These lists are separate; a patient may be placed on only one of these three lists.
When potential organs become available, the patient with the best match and most points on the list is notified by the transplant coordinator. The potential recipient will receive further instructions from the transplant coordinator on how to prepare for surgery.
After Surgery
After the transplant, the recipient is admitted to the intensive care unit (ICU). Most patients remain in the ICU for two to three days. Recipients will then be transferred to the specialized Renal and Transplant Unit. Function of the transplanted organ(s) will be closely monitored with laboratory and x-ray studies. The total hospital stay is approximately 10 days.
After Discharge
Following discharge from the hospital, medications that prevent certain types of infection, as well as rejection of the transplanted organ(s), will have to be taken. During the hospital stay, the transplant case manager provides education about these medications. Blood work, taken several times per week, enables the doctor to monitor the continued function of the transplanted organs. Follow-up clinic visits will be scheduled on a regular basis. With successful SPK or PAK transplantation, patients can expect to be free of insulin and dialysis.
It is our hope that patients will begin to enjoy a vastly improved quality of life following a successful pancreas transplant.
New Brunswick, NJ
Kidney & Pancreas Transplant at Robert Wood Johnson University Hospital
Livingston, NJ
Kidney & Pancreas Transplant at Cooperman Barnabas Medical Center