Pancreas Transplant

Conditions such as Type 1 diabetes (when the pancreas does not produce insulin at all) or pancreatitis (inflammation of the pancreas) can cause the pancreas to fail. This can cause serious illness.

There are three different types of pancreas transplant:

1. Simultaneous Pancreas Kidney (SPK) Transplant
   This is the most common surgery whereby the diabetic patient who also has kidney failure will receive both a kidney and a pancreas transplant simultaneously from a deceased donor to minimise tissue incompatibility. The transplanted pancreas will take over the function of the failed pancreas and produce the hormones and enzymes essential for health. This greatly reduces the possibility of diabetes-related complications in the future and the patient will no longer need insulin therapy. The transplanted kidney removes fluid and waste from the body and dialysis will no longer be needed.
2. Pancreas Transplant Alone (PTA)
   The surgery involves placing only a healthy pancreas into the patient. This is usually performed for patients with Type 1 diabetes and without kidney failure, whose blood sugar levels are difficult to control despite correct insulin injections, or have frequent hypoglycaemic attacks and hypoglycaemia unawareness.
3. Pancreas After Kidney (PAK) Transplant
   This surgery is usually performed when:
   
1. Patients with Type 1 Diabetes who have undergone a successful kidney transplant for treatment of kidney failure previously, but have difficulty controlling their blood sugar levels despite the doctor’s advice. Patients may be then recommended to undergo a pancreas transplant.
2. To avoid the need for dialysis, or a long waiting time on dialysis which may lead to additional health complications, patients may be recommended to go for a living donor kidney transplant first. The pancreas transplant will subsequently be performed upon availability of a pancreas from a deceased donor, after the patients have recovered from the kidney transplant surgery.

Simultaneous Pancreas Kidney (SPK) Transplant

SPK transplant is the most common surgery for patients with kidney failure and insulin-dependent diabetes. SPK transplant may be considered if:

• Type 1 diabetes cannot be well-controlled with standard treatment
• There are frequent insulin reactions (diabetic shock)
• Blood sugar control is poor
• There is severe kidney damage
  
• You have hypoglycaemic unawareness or frequent hypoglycaemic attacks
• A Type 2 diabetic has both low insulin resistance and low insulin production

Patients with Type 2 diabetes are less commonly offered SPK transplant as the cause of their diabetes is due to the body’s inability to use insulin and not because of the pancreas’ inability to produce insulin. However, some of them who are on insulin may be suitable to receive SPK transplants.

For diabetic patients who have received a SPK transplant successfully, they will have normal insulin production and improved blood sugar control, preventing many diabetes complications. They will no longer need any insulin injections and will be free from the dietary and activity restrictions which were caused by diabetes, improving their quality of life.

However, serious side effects may be caused by the anti-rejection medications taken after the transplant. Therefore, a transplant recipient has to be fit to undergo major surgery and the benefits of getting a SPK transplant must be outweigh the risks involved.

Your doctor will discuss the possibility of a SPK transplant with you if you are suitable.

1. I want to see a doctor at NUCOT. How can I refer myself?
2. What do I need to prepare for my first visit?
3. Who is eligible for a pancreas transplant?
4. Who can I get a donor pancreas from?
5. What are the criteria for me to be added to the national waiting list?
6. How long is the wait time?
7. How does the evaluation process work?
8. What do I need to prepare before the surgery?
9. What are the risks involved during surgery?
10. What happens during the surgery?

1. I want to see a doctor at NUCOT. How can I refer myself?

You can contact our clinic directly here to make an appointment with us.

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2. What do I need to prepare for my first visit?

You will need to bring:

1. Your medical records, test results and medical reports from your current healthcare provider.
2. Your list of medications, including traditional/herbal supplements.

Think about any question(s) concerning organ transplantation that you would like our doctors to address. If your family member(s) are involved in your decision making and would to find out more, you may ask them to join you for the first consultation.

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3. Who is eligible for a pancreas transplant?

The transplant team will assess your suitability for a pancreas transplant based on your:

• Medical history: not everyone is suitable for a pancreas transplant. You will need to be below 55 years old and do not have heart disease, hepatitis B, hepatitis C, HIV infection or cancer. You must not be severely overweight.
• Health: your body needs to be healthy enough to undergo surgery and tolerate post-transplant medications.
• Self-discipline: recommendations from the transplant team must be followed strictly and you will need to take the medications for life.
  

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4. Who can I get a donor pancreas from?

A donor pancreas comes from a deceased donor.

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5. What are the criteria for me to be added to the national waiting list?

You must be:

• A Singaporean or Permanent Resident
• Deemed medically suitable
  
• Less than 70 years old

Once you have decided to go ahead with a transplant, you will be placed on the national waiting list, where you wait for a suitable organ from a deceased donor to be available.

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6. How long is the wait time?

The wait time depends on your blood group as the deceased donor’s blood and tissue types must be a match.

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7. How does the evaluation process work?

Step 1

You will need to undergo several tests and screenings such as:

• Blood type: Your blood type should be compatible, even if it is not the same as the donor.
  

  ​Recipient blood group	​Compatible donor blood group	Incompatible donor blood group​
  ​O	O​	A, B, AB​
  A​	A, O​	B, AB​
  B​	B, O​	​A, AB
  ​AB	A, B, AB, O​	NIL​

• Tissue type test: This is a blood test for genetic makeup. The more genetic markers you share with the donor, the better the match.
• Mental health assessment: You will need to undergo a counselling session and be assessed for any psychological issues.
• Diabetes-related tests: To confirm the type of diabetes you have.

Step 2

You will be reviewed by the transplant doctor after the initial tests are done. If you are deemed potentially suitable for a pancreas transplant, you will then need to undergo a chest x-ray, electrocardiography (ECG) and more detailed heart scans, as well as other investigations as necessitated by your medical conditions. This will take at least two weeks.

Step 3

Appointments will be made for you to see doctors from various specialties as required, depending on your medical condition(s). For example, if you have a heart problem, you will need to see cardiologist. You will also undergo the final step of tests as required.

You will be seen by:

• A surgeon who will inform you the risks of the operation and discuss the details of the operation.
  
• A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for pancreas transplant.
  
• Other specialists as recommended by our transplant doctors.

Once the transplant team has assessed that you are suitable for a pancreas transplant, you will have a final review with the transplant doctor and be placed on the national waiting list.

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8. What do I need to prepare before the surgery?

To ensure that you are fit for transplant, the pancreas transplant coordinator will contact you regularly to arrange for tests or evaluations. You will need to take good care of yourself, especially while on dialysis.

These are some ways to increase your chances of a successful transplant:

• Take your prescribed medications on time
• Turn up for all your medical appointments
• Keep to a healthy diet and exercise regularly to maintain a healthy weight
• Quit smoking

It is important to remain contactable as the pancreas and kidney from a deceased donor may be available any time. You must come down to NUH for the transplant immediately as the surgery must happen within a few hours after the organs are removed from the deceased donor.

You may wish to prepare a bag with necessities on standby for your hospitalisation needs.

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9. What are the risks involved during surgery?

Some complications of a SPK transplant include:

• Blood clots
  
• Bleeding
• Infection
• Hyperglycaemia or other metabolic problems
• Urinary leaks/complications
• Bowel leaks/complications
• Failure or rejection of the donated pancreas and/or kidney

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10. What happens during the surgery?

Pancreas and kidney transplantation surgery involves placing the donor’s healthy pancreas and kidney into your abdomen. After the operation, the transplanted organs take over the functions of your failed pancreas and kidney.

The donor’s pancreas will be positioned on the lower right side of your abdomen. For SPK or PAK transplant, the donor’s kidney will be positioned on the lower left side of your abdomen. Both organs are surgically attached to the blood vessels nearby. The donor ureter (tube carrying urine from the transplant kidney to the bladder) will be attached to your bladder if the kidney transplant is done. The pancreas is attached to the small bowel for the drainage of digestive enzymes. The SPK surgery takes approximately eight to ten hours, whereas that for PA and PAK is generally shorter at six to eight hours.

Your own kidneys and pancreas will not be removed during the transplantation surgery.

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1. How long will it take for me to recover after the surgery?
2. What happens after discharge?
3. What do I need to take note of after the surgery?
4. What are the side effects of the anti-rejection medication?
5. What are the signs and symptoms of pancreas and/or kidney rejection?
6. What if my body rejects my new pancreas and/or kidney?

1. How long will it take for me to recover after the surgery?

After the surgery, you will be in the High Dependency Unit for a few days so that you can be monitored closely. The transplanted pancreas may not work immediately after the operation, therefore insulin injections will be continued for a period of time.

Once your condition stabilises, you will be transferred to a normal ward to recuperate for about a week. There will be soreness or pain around the surgery site.

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2. What happens after discharge?

Your transplant team will develop a check-up schedule for you as close monitoring is needed for the next one month. It is important that you keep to your regularly scheduled appointments.

You will need the take the anti-rejection medications for life to help prevent your body from rejecting the new organs. Without proper levels of these immunosuppressants, the pancreas and kidney will be rejected and you will once again need to inject insulin to control your blood sugars or to start dialysis for treatment of the kidney failure. During the check-ups, the transplant team will assess if your newly transplant organs are functioning well and adjust your immunosuppressive medicines as needed.

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3. What do I need to take note of after the surgery?

Mental Health

It is normal to have a mix of emotions as a transplant is a major life change. There could be several reasons, such as mood changes due to the immunosuppressants or feeling stressed about your new lifestyle. You are not alone.

Let your transplant team know how you are feeling so that they can help to support you and adjust your medicine if needed. They may also refer you to a psychologist.

Diet and nutrition

Maintaining a healthy diet and exercising regularly can help to prevent some common post-transplant complications such as heart attacks. It will also help to keep your pancreas and kidney healthy.

Your transplant team will refer you to a dietitian who will work around your nutrition and dietary needs and recommend you foods for your nutrition plan. You can also discuss with the dietitian if you have any questions.

Exercise

You can explore walking, jogging, cycling, swimming and other low-impact physical activities. Check in with your transplant team if you want to start or change your post-transplant exercise routine.

Travel

It is important to have recovered fully before you travel overseas. Your transplant team may recommend that you wait between two and twelve months after your surgery before you travel. You will need to have enough immunosuppressants for your overseas trip. Let your transplant team know your travel plans as you may need to take vaccines or avoid certain foods depending on your destination.

Driving

It is recommended to wait for at least two weeks after your transplant before you start driving. Some of the medications you need to take right after the surgery may cause tremors and vision changes. It will be safer to have company in your ride when you start driving again.

Sex Life and Pregnancy Plans

Avoid having sex for four to six weeks after your transplant until your surgery site has healed to prevent the wound from opening again.

For females, your menstrual period may become more regular after the transplant. This means that you will more likely to become pregnant. It is recommended to wait one year after your transplant before getting pregnant. Check in with your doctor to find out which birth control method will be more suitable for you.

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4. What are the side effects of the anti-rejection medication?

The side effects may include:

• Osteoporosis
• High cholesterol
• High blood pressure
• Nausea
• Diarrhoea
• Sensitivity to sunlight
• Weight gain
• Swollen gums
• Acne
• Excessive hair growth or hair loss
• Cataracts
  

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5. What are the signs and symptoms of pancreas and/or kidney rejection?

Signs and symptoms that your body may be rejecting your new pancreas include:

• Fever of more than 38oC
• Excessive tenderness at the surgery site
• Vomiting episodes
• Decreased urination
• Increased blood sugar levels
• Pain at the stomach area

Signs and symptoms that your body may be rejecting your new kidney include:

• Fever of more than 38oC
• Unexplained weight gain
• Ankle swelling
• Very high blood pressure
• Flu symptoms such as body aches, headaches and chills
• Less urination
• Excessive tenderness at the surgery site
• Extreme tiredness

Inform your transplant team immediately if you experience any of these symptoms.

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6. What if my body rejects my new pancreas and/or kidney?

Pancreas

It is not unusual if your body rejects the new pancreas within the first few months of your transplant. Your transplant team will put you under intensive anti-rejection medications for treatment.

Kidney

There are two types of kidney rejection that may happen after your surgery:

1. Acute Rejection
   This happens usually within three to six months after your transplant. The acute rejection episodes mean that the body is fighting the new kidney. Less than 5% of transplant patients will have an acute rejection episode which causes a complete failure of the new kidney.
2. Chronic Rejection
   This is more common and usually occurs slowly over the years. Your new kidney may stop working because your immune system is constantly fighting it.

Having a rejection episode does not mean that your new kidney is not working or will be completely rejected. You will need to talk to your doctor about the episode(s) and they will change the amount of your immunosuppressive medications you need to take. It is extremely important to follow your prescription to prevent kidney rejection.

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National University Centre for Organ Transplantation (NUCOT) provides pre and post-transplant patients with comprehensive, dedicated and individualised care. We also welcome potential living organ donors to get in touch with us.

Referrals to NUCOT

NUCOT takes in self-referrals and referrals from healthcare practitioners. Patients can do a self-referral by contacting our NUCOT clinic directly or have your primary physician refer you to us.

Click here for our NUCOT clinic’s location, contact details and operating hours or to make an appointment with us.