Kidney and pancreas transplant

Overview

A kidney-pancreas transplant, also known as simultaneous pancreas and kidney (SPK) transplant, is a surgical procedure intended for individuals with both kidney failure and Type 1 diabetes, though some patients with Type 2 diabetes may also qualify. The procedure aims to restore kidney function and regulate insulin production, addressing both conditions concurrently.

Kidney failure is a common complication of poorly managed Type 1 diabetes over time. In these cases, a kidney-pancreas transplant is recommended to restore both kidney function and natural insulin production.

Although there are risks of organ rejection and infection, the overall outlook for kidney-pancreas transplant (SPK) recipients is generally positive, making it a good option for some with both kidney failure and Type 1 diabetes. However, not everyone qualifies, and a transplant team will evaluate each candidate to see if they are eligible.

Reasons for undergoing the procedure

A kidney-pancreas transplant is recommended for individual with Type 1 diabetes who is nearing or has developed kidney failure.

Transplant centers use various criteria to assess people whether they are a suitable candidate for the procedure, before placing them on the transplant waiting list. These include:

• Overall health
• Physical and psychological exams
• Tests to check the function of the kidneys, pancreas, heart, lungs, bladder, and other organs.
• Medical conditions like cancer
• History of smoking or substance use

Risks

A kidney-pancreas transplant carries a higher risk of surgical complications compared to a single organ transplant, like a kidney-only transplant. The main concerns are infection and organ rejection, where the body tries to reject the new organs.

Immunosuppressant medications are used to prevent rejection, but they must be taken for life. These medications weaken the immune system, making patients more prone to infections and other illnesses.

Healthcare providers will regularly monitor one’s blood to help prevent organ rejection. It is recommended to seek medical assistance if any of the following symptoms are experienced:

• Fever
• Blood clots
• Excessive bleeding
• Pain during urination
• Pus or fluid drainage from the transplant site
• Tenderness at the transplant site
• In rare instances, leaks in the small bowel or bladder, which may require further surgery to repair

Procedure

A kidney-pancreas transplant involves placing healthy organs in the body to replace the functions of a failing kidney and pancreas. Most people who undergone the transplant stay in the hospital for 8 to 12 days, though some may stay for up to a month.

A kidney for transplant can come from either living or deceased donors, but a pancreas must come from a deceased donor. Typically, both organs for a kidney-pancreas transplant come from the same deceased donor.

Donors are thoroughly screened to ensure compatibility with the recipient’s tissue and blood type and to prevent any diseases. If one is approved for a kidney-pancreas transplant, they are placed on a waiting list with the United Network for Organ Sharing (UNOS). When a suitable donor is found, surgery must take place within 12 hours of organ removal.

Transplant procedure may involve these steps:

• General anesthesia is administered for the duration of the surgery.
• An incision is made in the abdomen to access the transplant site.
• The donor kidney is positioned in the lower right or left side of the abdomen.
• The donor kidney’s vein and artery are connected to nearby blood vessels.
• The ureter of the transplanted kidney is attached to the bladder to enable urine flow. In most cases, the original kidneys are not removed.
• The donor pancreas is placed on the lower right side of the abdomen.
• The pancreas is connected to veins, arteries, and the small bowel during transplantation. The vein and artery of the transplanted pancreas are attached to corresponding blood vessels.
• A small section of donor small bowel is connected to the pancreas to allow pancreatic juices to flow into the digestive system, supporting digestion.
• The original pancreas typically remains in place.
• The transplanted organs usually begin functioning within a few hours, with the pancreas producing insulin to regulate blood sugar levels.

Outcome

A successful transplant increases strength, energy, and stamina, enabling most recipients to return to a more normal lifestyle with better daily management. Many report a notable improvement in their overall quality of life.

After a kidney-pancreas transplant, one who previously required dialysis will gain more freedom as they will no longer need regular treatments. The pancreas transplant helps regulate blood sugar, often eliminating the need for insulin injections.

A combined kidney-pancreas transplant significantly enhances both quality of life and life expectancy. There is an 80% chance the patient will not need insulin or dialysis for at least one year, and a 70% chance they would not require these treatments for the next five years.

In some cases, a pancreas transplant can be performed without a kidney transplant, or it may be done later following a kidney transplant.

Pancreas transplant complications are similar to those of a combined kidney-pancreas transplant, but the long-term success rate is lower. However, improved drugs and tissue-matching techniques have increased the chances of success. A healthcare provider will decide if a pancreas transplant alone is needed, based on one’s medical condition.