Kidney/Pancreas Transplant Process
Since 1989, California Pacific Medical Center has offered diabetic patients the option of a combined kidney/pancreas transplant for treatment of both kidney failure and diabetes. This alternative, which is suitable for patients with insulin-dependent (Type 1) diabetes, not only restores the quality of life for patients living with end-stage renal disease but also eliminates the daily burden of insulin shots and blood glucose monitoring. The new kidney can filter poisons out of your body while the new pancreas makes insulin automatically, as your body needs it.
Medical and surgical advances have improved the success rate and decreased the risks of pancreas transplantation. Because of these advances, the number of kidney/pancreas transplants has steadily increased and the one-year transplant survival rate is now the same as kidney transplantation alone. Although not an option for everyone, for many patients kidney/pancreas transplantation has become the preferred treatment for end-stage renal disease resulting from diabetes.
Your Pancreas and Its Function
The pancreas is an organ near your stomach that produces digestive juices and insulin, a hormone that helps cells take in the glucose they need. When the pancreas stops making insulin, glucose builds up in the blood and diabetes develops. Diabetics must take daily insulin shots to provide cells with the energy they need.
When a diabetic patient undergoes kidney/pancreas transplantation, the pancreas begins to produce insulin immediately and the blood sugar falls to a normal level within hours of the transplant. Insulin shots are no longer required once the patient recovers sufficiently from the surgery and can begin eating an unrestricted diet. Glucose levels, both before and after meals, stay in the normal range following transplantation and glycohemoglobin levels return to normal within a couple of months after surgery.
Pancreas transplant recipients point out that they no longer worry about skipping a meal, doing too much exercise or experiencing episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). In addition, the pancreas protects the new kidney from being affected by recurrent diabetes. The pancreas transplant may influence the course of other diabetic complications, including neuropathy and eye disease, although patients who have been diabetic for many years may have already sustained significant irreversible damage to the nerves and eyes.
In comparison to a kidney transplant, combined kidney/pancreas transplantation requires a longer initial hospitalization as well as more frequent follow-up after surgery. In addition, because of the increased complexity of the surgery, the risk of complications is higher than with kidney transplantation.
Candidates for Kidney/Pancreas Transplantation
The typical patient for a kidney/pancreas transplant is a Type 1 or juvenile-onset diabetic who has developed kidney failure and is either on hemodialysis or peritoneal dialysis, or who will need dialysis within the next six months to one year. Candidates for kidney/ pancreas transplantation have several options open to them, including remaining on dialysis, kidney transplantation or a combined kidney/pancreas transplant. Ultimately, patients must decide which treatment is best for them.
After a thorough evaluation to determine if transplantation is appropriate, patients eligible for kidney/pancreas transplantation are placed on the same waiting list as those waiting for a kidney transplant alone. Not all cadaveric kidney donors make good pancreas donors, however. Patients waiting for a combined kidney-pancreas transplant receive priority over patients waiting for a kidney alone and the average wait is between two to three years. Sometimes, patients may choose to receive a kidney from a family member or close friend and then receive a pancreas from a cadaver donor at a later date.
Kidney/Pancreas Transplant Surgery
At the time of one's kidney/pancreas transplant surgery, the transplant physician will check for fever, infections or other serious conditions which if present, may prevent surgery. Patients will undergo several blood tests as well as a chest X-ray and EKG. Dialysis may also be necessary before the surgery. After these preparations, the patient will be taken to the operating room where after receiving a general anesthetic, he or she will quickly fall asleep. The transplant surgeon will place an intravenous (IV) catheter into the subclavian vein (beneath the collarbone) to administer medications, monitor pressures and retrieve blood for laboratory tests during hospitalization.
Once the patient is asleep, the incision site will be shaved clean to prevent infection and a Foley catheter will be inserted in the bladder. The surgeon will then make an eight- to 10-inch incision in the center of the abdomen. The donor kidney is placed on the left side of the lower abdomen and connected to the arteries and veins in the pelvis. The donor pancreas is placed on the right side of the pelvis, above the bladder. The pancreatic secretions are drained into the small intestine. The old pancreas and kidney are left in place and do not harm the new organ. The surgical procedure takes between four to six hours.
Following surgery, patients recover in the medical-surgical intensive care unit (MSICU), a specialized area of the hospital where close monitoring will be in effect for 24 to 48 hours. Once the vital signs and function of the transplanted kidney and pancreas have stabilized, patients are transferred to the regular nursing floor where our team of specialists continues to provide postoperative care. The Foley bladder catheter is usually removed after four to five days. On average, the hospital stay for kidney/pancreas transplant recipients at California Pacific is between 10 to 12 days. Patients can expect to resume normal activities within eight to twelve weeks following surgery.
About California Pacific Medical Center
California Pacific Medical Center, part of the Sutter Health Opens new window network, offers kidney, pancreas, liver and heart transplantation as part of our Barry S. Levin, MD Department of Transplant.
Kidney & Pancreas Transplant Program
California Pacific Medical Center
2340 Clay Street
San Francisco, CA 94115
Outreach locations available throughout Northern California and in Reno.