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Multi-Organ Transplant
Pancreas-Kidney Transplant
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Frequently Asked Questions
What is a kidney/pancreas transplant?
Am I a candidate for a kidney/pancreas transplant?
Am I a candidate for a pancreas transplant alone?
Is a person with Type 2 Diabetes a candidate for a kidney/pancreas transplant?
What are the benefits of a kidney/pancreas transplant?
What are the risks of a kidney/pancreas transplant?
What is the success rate of a kidney/pancreas transplant?
Where does my new kidney or new pancreas come from?
What is the procedure for receiving a deceased donor transplant?
How long will I have to wait before I receive my transplant?
What happens during the kidney and pancreas transplant surgery?
How do I ensure the success of my transplant?
What kind of contact can a transplant recipient expect to have with the deceased donor’s family, or a living kidney donor?
How can I get more information about kidney/pancreas transplantation?
What is a kidney and/or pancreas transplant?
A kidney transplant is an organ transplant that involves implanting a healthy kidney (one that can filter the blood) into a person with kidney failure.
A pancreas transplant is an organ transplant that involves implanting a whole healthy pancreas (one that can produce insulin) into a person who has Type 1 Diabetes.
There are three main types of transplantation performed by the Toronto Pancreas Transplant Program at Toronto General Hospital:
- Simultaneous pancreas-kidney transplant (SPK) when the pancreas and kidney are transplanted simultaneously from the same deceased donor
- Pancreas-after-kidney transplant (PAK) when the pancreas transplantation is performed after a previous kidney transplantation, and
- Pancreas transplant alone (PTA) for patients with Type 1 Diabetes suffering from severe, hypoglycemic unawareness, but adequate kidney function.
Am I a candidate for a kidney/pancreas transplant?
If you have Type I Diabetes and you have kidney failure (or the beginning of kidney failure), a combined kidney and pancreas transplant could be an appropriate treatment option. You require a doctor’s referral to be considered a candidate for the Toronto Pancreas Transplant Program. Your acceptance into the Program is based your medical condition, your overall health, and the results of an individualized pre-transplant evaluation. The evaluation includes a complete physical examination, a series of tests (including heart and vascular evaluations) and consultations with the transplant coordinator, the transplant kidney specialist and the transplant surgeon.
Am I a candidate for a pancreas transplant alone?
A pancreas transplant alone can be an excellent treatment option for Type 1 diabetics before dialysis is required and when conventional insulin therapy and glucose management becomes unpredictable and difficult to control.
Is a person with Type 2 Diabetes or Pancreatic Cancer a candidate for a pancreas transplant?
No. Type 1 Diabetes and Type 2 Diabetes are fundamentally different. With Type 1 Diabetes, the pancreas does not produce insulin. With Type 2 Diabetes, the pancreas continues to produce insulin, but the body does not properly use the insulin it makes. If you have Type 2 Diabetes, glucose builds up in your blood instead of being used for energy. Blood glucose levels must be managed by eating healthy meals and snacks, regular physical activity and taking diabetes medications (including insulin), as prescribed by a doctor.
Patients with pancreatic cancer are not eligible for pancreas transplant. Other treatment options are available. Talk to your doctor.
What are the benefits of a kidney/pancreas transplant?
A transplant can improve the length and quality of your life. You will feel better, spend less time in hospital, enjoy a normal diet and return to a more normal lifestyle.
After a successful kidney/pancreas transplant dialysis and insulin therapy are no longer required. The new kidney filters your blood and the new pancreas produces insulin to regulate your blood sugar. After transplantation, your blood sugar level before and after eating is normal. A pancreas transplant can also help stabilize other diabetic complications.
[top]What are the risks of a kidney/pancreas transplant?
As with any surgical procedure, an organ transplant carries some risk. Possible complications include infection and bleeding. Rejection is also a risk and occurs when your immune system recognizes the new organ as a foreign body. Rejection is treated with immunosuppressant medications you must take for the rest of your life.
Immunosuppressant drugs by definition, “suppress” the immune system avoiding organ rejection but also making the patient more susceptible to certain infections. Other medications that fight viral and bacterial infections can offset this risk. Immunosuppressants can also cause other possible side effects such as high blood pressure or osteoporosis. Close monitoring and dosage adjustments can lessen these side effects.
What is the success rate of a kidney/pancreas transplant?
Over the last 15 years, ground-breaking advances in transplantation at Toronto General Hospital continue to deliver high patient survival rates, long term glucose control and an excellent quality of life for patients suffering from Type 1 Diabetes and end stage renal failure.
The Toronto Pancreas Transplant Program has performed more than 285 pancreas-kidney and pancreas-after-kidney transplants to date. Advanced surgical techniques, modern immunosuppressant therapies and world class patient-centred care help to ensure high success rates (>95 percent in the first year).
Where does my new kidney or new pancreas come from?
Kidneys for transplantation come from living donors or deceased (non-living) donors. Living donors can be immediate family members, friend or anonymous. A pancreas for transplantation must come from a deceased donor. Deceased donors provide organs for transplantation at the time of death. A simultaneous pancreas-kidney transplant or a pancreas transplant alone is performed with deceased donor organs. A pancreas-after-kidney transplant might include a kidney from a living donor, followed by a pancreas from a deceased donor.
All donors are carefully screened to prevent any transmissible diseases or other complications. The donor is also carefully evaluated to make sure they are a suitable match to the recipient’s tissue and blood type.
What is the procedure for receiving a deceased donor transplant?
Type 1 diabetics accepted to the Toronto Pancreas Transplant Program are placed on a waiting list to receive a donor kidney and/or pancreas. When a kidney or pancreas becomes available, they are matched to a recipient on the list based on blood type, tissue type, cross-match compatibility, and recipient’s wait time on the list. Once a match is identified, the recipient is notified and preparations for surgery begin.
How long will I have to wait before I receive my transplant?
Kidney/pancreas transplant candidates are a special group, on a separate transplant list with unique donor requirements. The average wait time compares favourably in relation to the wait time for kidney transplantation. Some people must wait longer than others because their blood and tissue types are less common, or because they have higher risks of complications or rejection (such as a build-up of antibodies).
What happens during the kidney and pancreas transplant surgery?
The new kidney is placed on the lower side of the abdomen where it is surgically connected to nearby blood vessels and the bladder. The vein and artery of the new kidney are attached to your vein and artery. The new kidney ureter is attached to your bladder to allow urine to pass.
The new pancreas is placed on the lower side of your abdomen where it’s surgically connected to nearby blood vessels. The vein and artery of the new pancreas are attached to your vein and artery.
The recipient’s native kidney and/or pancreas are left in place. Their function may be limited, but they may still contribute to overall health. The pancreas for example, performs additional functions necessary in the digestive processes.
The kidney and pancreas transplant surgery takes from five to seven hours. Transplant patients generally stay in the hospital about 7 to 12 days.
How do I ensure the success of my transplant?
- Take the immunosuppressant medications as prescribed by your doctor. If you adhere to the medications prescribed, you lessen the chance your body will reject your new organs.
- Attend your transplant clinic. You’re required to attend regular health clinics and have your blood work drawn as scheduled. Your clinic includes a visit with your doctor and your transplant nurse coordinator to monitor your health for any signs of infection or rejection.
- Do blood work regularly. Your transplant team will let you know how often. At the beginning, you will need to do blood work at the Hospital. Later on, you can do it at a lab close to home. The frequency of blood tests decreases over time.
- Communicate. Engage your healthcare providers and caregivers. Ask questions, talk about how you’re feeling and describe any changes in your health. Your feedback will help ensure you receive the best possible care.
What kind of contact can a transplant recipient expect to have with the deceased donor’s family, or a living kidney donor?
The donation process is anonymous. The recipient does not know the identity of the donor or the donor's family – unless of course the living kidney donor is a family member or friend.
It’s often appropriate for a recipient to express their gratitude in a letter to the donor family. Some recipients struggle with what to say, or how to say it. A simple, short letter can be effective. The underlying sentiment is usually just "thank you".
The transplant coordinator can help you write and deliver the letter. It’s an emotional time. The donor family may or may not respond to a recipient’s letter.
How can I get more information about kidney/pancreas transplantation?
For more information about kidney/pancreas transplantation, ask your doctor or email Pancreas.Info@uhn.on.ca
