Pancreas Transplantation Process
Once a patient is referred for consideration to receive a pancreas transplant, an appointment for evaluation is made at the Transplant Clinic at Memorial Hermann-Texas Medical Center. This first appointment begins the process of the medical and surgical evaluation to ensure that pancreas or pancreas-kidney transplantation is the right option for the patient.
Pancreas Transplant Evaluation
The pancreas transplant evaluation process starts with a pre-transplant evaluation of the patient and, if, the patient is suitable candidate, he/she is placed on the pancreas or pancreas-kidney transplant list. As a first step, the patient will receive a thorough evaluation from the pancreas-kidney transplant team, which includes transplant nephrologists, transplant surgeons, transplant nurses, transplant coordinators, financial counselors, social workers and dietitians.
The overall evaluation takes approximately three days and includes:
- Diagnostic & Blood Testing - Necessary tests may include blood tests, x-rays, ultrasounds, CT scans and cardiac testing.
- Appointments to See Other Specialists - Referrals to other physicians, such as endocrinologists, cardiologists, gynecologists, urologists and gastroenterologists, may be necessary. The purpose of these referrals is to determine if it is safe to proceed with pancreas or pancreas-kidney transplantation.
- Psychosocial Evaluation - The psychosocial evaluation helps prepare the patient and loved ones for pancreas or pancreas-kidney transplantation. Financial counselors are also available to help make necessary arrangements prior to transplantation.
- Patient Education - The Transplant Center's commitment to patient education begins at the first visit. Understanding the transplant process is a crucial part of successful transplantation.
Once the evaluation is complete and the results of the tests are received, the multidisciplinary transplant team will confirm that pancreas or pancreas-kidney transplantation is the correct option for the patient. If the patient is deemed a transplant candidate, the patient will be placed on the United Network for Organ Sharing (UNOS) wait list for deceased-donor pancreas or pancreas-kidney transplantation.
Pancreas and Pancreas-Kidney Transplantation Waiting List
Pancreas and pancreas-kidney transplant patients primarily receive their organs from deceased donors. Deceased donor organs are scarce and in most cases are distributed to potential recipients based primarily on waiting time. The UNOS administers the national pancreas and pancreas-kidney transplant waiting list. Waiting times vary depending on blood type. Pancreas and pancreas-kidney is most successful when the organs are recovered from younger, otherwise-healthy donors.
Patients awaiting pancreas or pancreas-kidney transplantation on the transplant list are seen by Transplant Center physicians on an annual basis to ensure that they are still candidates for transplantation and will be ready when the organ(s) become available.
Become an Organ Donor
The generosity of deceased donors is the foundation of organ transplantation and provides hope for the more than 100,000 people waiting for an organ transplant nationwide. Please visit donatelifetexas.org for more information on organ donation.
When a deceased donor pancreas or pancreas-kidney becomes available, the patient will be notified and admitted to the hospital. The patient will again meet with a nephrologist and a transplant surgeon who will answer the patient’s questions, and the patient will sign a consent form authorizing the procedure.
Kidney/Pancreas Transplant Procedure
If the patient has been on dialysis, he or she may require a session of dialysis prior to the transplant procedure. The Transplant Center provides both hemodialysis and peritoneal dialysis, so it is unnecessary for the recipient to bring his/her peritoneal dialysis supplies. Sometimes, a final matching test (histocompatibility) must be done before the transplant can happen. If the patient and donor do not match, the patient may have to wait for another kidney.
In the transplant procedure, the kidney and pancreas will be transplanted at the same time. It is performed under general anesthesia and typically takes about 3-6 hours. The team of specialized transplant anesthesiologists will ensure that our patients receive the best available care while the kidney/pancreas transplant is being performed. A plastic stent is usually placed inside the ureter and bladder during the procedure and will be removed by an urologist several weeks after the transplant.
Following the procedure, patients are taken directly to a dedicated Transplant Surgery Intensive Care Unit (TSICU) to recover. Most patients spend two to three nights in this unit before being transferred to the regular transplant surgery floor. Many patients have immediate function of the transplanted kidney and will not require any dialysis after the transplant procedure. The hospital stay following a kidney/pancreas transplant is typically 7-10 days.
Possible Transplant Risks
Pancreas and pancreas-kidney transplantation carries associated risks, including the risk of the body rejecting the implanted organ(s), the risk of infection and the increased risk of cancer from the immunosuppression (anti-rejection) medication administered to reduce the risk of rejection.
It is important to know that rejection does not usually mean loss of the transplanted organ. Rather, rejection simply means that the balance of the immune system and the organ has changed, and immunosuppression needs to be increased. Your doctor will discuss the risks associated with transplantation with you prior to your procedure.
Although hospitalization is relatively short following pancreas and pancreas-kidney transplantation, the affiliated physicians and staff will continue to monitor our recent transplant recipients very closely in the clinic during recovery. Patients enjoy the comfort of home as they recover yet still receive their necessary medical attention at our clinic.
Clinic visits are scheduled weekly or twice weekly during the early period after transplant, and the time between visits will be increased according to the patient's needs. Patients from outside the Greater Houston area should plan to stay in Houston for three to four weeks after transplant to allow for close follow-up.
Life after Pancreas-Kidney Transplantation
The goal of pancreas or pancreas-kidney transplantation is to return patients to a full, satisfying quality of life, since they are off insulin and no longer have strict dietary and travel restrictions. Many patients go back to school, work and activities they enjoyed prior to having organ failure.
One year after transplant, the patient will be referred back to see his/her original nephrologist. This is done so that the patient can always have an expert physician, located near their home or work, caring for them. The patient will typically see his/her nephrologist two to four times a year.
The nephrologist will address problems with hypertension, diabetes and worsening pancreas-kidney function, if the transplant is failing. The Transplant Center will continue to see the patient annually and conduct laboratory tests every month for three years and then every three to four months for the life of the transplants. The Transplant Center communicates with the patient's nephrologist openly to provide optimal joint care for the transplant patient.
Transplantation can sometimes seem overwhelming for patients. The Transplant Center offers a transplant support group that is run by our transplant social workers. The support group meets monthly and encompasses patients who are both waiting for a transplant and those who have already received a transplant.
Every other month, a guest speaker is invited to talk about a topic of interest to the support group. In between, the support group functions in a more traditional way where patients share their experiences, provide insightful help and recommendations, ask questions and form relationships with other patients experiencing similar issues. Adult family members, friends and caregivers are welcome and encouraged to come with the patient.
To find out more about pancreas transplantation or to schedule an appointment with an affiliated physician at the Transplant Center, please call (713) 704-5200.
If you are a physician and would like to refer a patient to the Transplant Center, click here.