Am I a good candidate for a pancreas transplant?
You will need a thorough evaluation by the Transplant Institute staff, in
consultation with referring physicians, to determine if transplantation is
the best treatment option. Being a good candidate for transplant depends
upon your physical health, emotional well-being, and ability to manage
medication and care plans.
People with type 1 diabetes (inability to produce insulin), chronic
pancreatitis or traumatic loss of pancreas may be candidates for a pancreas
transplant. However, those with type 2 diabetes, where the body is unable
to use the insulin it produces, generally do not benefit from a pancreas
How will a pancreas transplant benefit me?
One of the biggest benefits to a pancreas transplant for people with type 1
diabetes is lifestyle improvement. You will no longer need insulin
injections, and you can enjoy a regular diet. Depending on your health
before the transplant, you are also likely to experience greater
independence and activity. Protection from kidney damage is the other
significant benefit because the new pancreas will help prevent high blood
sugar from damaging your body.
How soon after the pancreas transplant can I stop taking insulin?
Following a successful pancreas transplant, your new organ will begin
making insulin right away. Initially some hospitalized patients may need to
take low levels of insulin so as not to stress the newly transplanted donor
pancreas. However, by the time most people are ready to go home, they are
no longer taking insulin and they are able to enjoy a regular diet.
I have just been diagnosed with type 1 diabetes. Will a pancreas transplant
help reduce my risk of vascular disease, retinopathy, and other health
concerns brought on by diabetes?
Yes, a pancreas transplant will help reduce your risk of vascular disease,
but it will not reverse any vascular disease that is present at the time of
your transplant. It will prevent progression of retinopathy (a degenerative
disease of the retina) and in some cases may reverse already established
symptoms of this eye disease. A pancreas transplant will also improve
peripheral neuropathy, although strict sugar control will also reverse this
condition. With peripheral neuropathy, injury to the peripheral nerves,
which carry signals between the central nervous system (spinal column and
brain) and the internal organs, muscles and skin, can produce tingling,
pain and debilitation.
I have a mild case of diabetes that is easily controlled. Am I eligible for
a pancreas transplant?
A pancreas transplant is generally not for patients who have a mild case of
type 1 diabetes that responds well to insulin therapy and certain diet
restrictions. Some people consider transplant because they do not want to
deal with certain lifestyle issues: limitations in diet, monitoring blood
levels or needing three and four needle shots a day.
Other patients consider pancreas transplant because they have "brittle"
diabetes, with very severe and sudden symptoms and complications from type
1 diabetes. These are people who have dangerous hypoglycemic unawareness.
They pass out frequently because they are completely unaware that their
blood sugar is getting low. Having one of these episodes while driving a
car or sleeping can be life threatening. Apart from regulating blood sugar,
a new pancreas for these patients may protect against kidney disease and
other long-term complications of diabetes. Some patients with diabetes, who
have already received a donor kidney, consider pancreas transplantation to
protect their new kidney from health complications from diabetes.
What are the benefits of pancreas after kidney (PAK) transplantation?
For certain patients with type 1 diabetes, research shows that pancreas
after kidney (PAK) transplantation helps improve blood sugar control
without the need for insulin injections; improve the longevity of the
kidney transplant; prevent recurrent kidney disease, brought on by
diabetes, in the transplanted kidney; stabilize, and possibly reverse, a
number of diabetes-related conditions such as kidney disease, nerve
dysfunction and eye disease in some patients; and improve the overall
quality of life.
How do I get a pancreas?
Patients who need a pancreas transplant are listed with the United Network
for Organ Sharing (UNOS). UNOS administers and maintains the national organ
transplant waiting list.
The New England Organ Bank (NEOB) is the local (regional) procurement
organization for Beth Israel Deaconess Medical Center, and shares organs
through UNOS. Staff at NEOB will enter your medical information into a
computer and will notify our transplant team when an organ becomes
available based on your waiting time on the list, blood type and other
All organ procurement organizations and Transplant Institutes belong to
UNOS. The NEOB operates according to policies set by UNOS, which is
supervised by the federal government. Donor pancreases from deceased
individuals are a precious national resource. The NEOB helps ensure equal
access to all patients who need a pancreas for transplant by balancing the
needs of patients who have waited a long time with the goal of
transplanting well-matched pancreases. It is a complex process. Please talk
to the Transplant Institute team if you have questions.
How long will I wait on the list?
There is no guarantee when a deceased donor pancreas will become available.
It could be months or years. The average waiting time for a deceased donor
pancreas in New England is between 1 to 2 years. The waiting time is longer
for patients with blood type O or B, and shorter for patients with blood
type A or AB.
If you need a simultaneous pancreas/kidney transplant, from the same
deceased donor, the wait time could be from 3 to 5 years. For this reason,
we strongly advise patients to consider talking to family members, friends
and others about living kidney donation followed by a deceased donor
Patients who have a living kidney donor may be able to avoid dialysis, or
may spend less time on dialysis than if they had to wait for a deceased
donor kidney. This has a number of health benefits for the transplant
What medication must I take?
You must always take anti-rejection medications for as long as you have a
functioning transplant. You will also need medications to prevent infection
for a short time after your transplant. Additionally, you may need at some
point in time medications to control blood pressure and prevent fluid
You are responsible for managing your own medication schedule, as
determined by the Transplant Institute team. You should never stop taking
your medication or change the dose without approval from the transplant
team, even if you experience unpleasant side effects. Tolerating some side
effects temporarily may be necessary in order to prevent organ rejection.
Tell your transplant team about any side effects that bother you. Your
doctor may be able to adjust your medication.
What is the success rate for pancreas transplantation?
Pancreas transplant is successful in about 90 percent of patients who no
longer have to take insulin injections within the first year following the
surgery. After the first year, more than two-thirds of pancreas transplant
recipients are still off insulin. The rate of organ function is very high,
with a half-life of about 10 years. In other words, after 10 years, half of
the transplanted pancreases are still working, which in terms of organ
transplants is very good. Those that are still working typically go on to
work for many more years. Surgeons are hopeful that this success rate will
climb even higher in the future because of ongoing improvements in
medication that support the functioning of the transplanted pancreas.
What if I reject the new pancreas?
Rejection is a signal that the patient's immune system has identified the
new pancreas as foreign tissue and is trying to get rid of it. Preventing
rejection with immune-suppressing medication is the first priority. The
most common sign of rejection is change in pancreas function (an elevation
of pancreas enzymes and/or glucose levels), as measured by a blood test. If
the rejection episode is verified through blood work, biopsy and
ultrasound, then the transplant team will increase the amount of
anti-rejection medication or prescribe a different combination of
anti-rejection drug therapy. Using medicine, we can successfully reverse
most rejection episodes, if we detect it early enough. However, if the
episode is severe, it may shorten the overall life span of the new
How often will I have to go into the Transplant Institute after my
For the first three to six months after your transplant, you will have
frequent follow-up visits with the transplant team and frequent laboratory
tests. Gradually, however, you will see the transplant team less often. At
this stage, you can look forward to having more time for yourself and your
activities. You will become even more responsible for maintaining your own
As you begin to see the transplant team less often, many of your healthcare
visits will be to your primary care physician and/or nephrologist,
diabetologist and other specialists as needed. Always tell your healthcare
providers that you have had a transplant, so if you do become ill, they can
determine whether your symptoms are, or are not, related to your
transplant. We recommend you keep a list of your current medications, as
well as any drug allergies, with you at all times.
Do I have to follow a special diet after a pancreas transplant?
Because of the medication you must take, transplant patients are more
likely to be affected by germs that may be on or in foods. You should wash
all fruits and vegetables thoroughly before eating and avoid raw or
undercooked meat, poultry, fish, sushi, raw shellfish and raw eggs in any
form (including cookie dough and eggnog). Also, you cannot have grapefruit
or any juices or beverages containing grapefruit because they will
interfere with your medications.
Because you feel better with your new organ, your diet will be less
restricted. Also, some medicines may increase appetite. Therefore, it is
very important for you to follow a healthy diet to avoid gaining too much
weight. The transplant team works with each patient to develop an
individualized diet plan, taking into consideration special needs and
Can I exercise?
Yes! It will take time to regain strength and endurance after a transplant,
but eventually you can resume normal activity. Walking and stair climbing
are excellent exercises for maintaining muscle tone and strength. You
should consider walking 5 to 10 minutes a day when you first arrive home
following surgery and then slowly increase the time you walk each week. Do
not begin strenuous exercises, such as contact sports, jogging, tennis and
weightlifting, for at least two months after the operation. It is normal to
tire easily so you should rest when tired.
Are there any restrictions I must follow?
You should not smoke after transplant and every attempt to quit prior to
the transplant is crucial to extend your life and the life of the new
pancreas. The transplant team will let you know when you can begin to drive
again, return to work or school, and travel. You can decide when to resume
sexual activity depending upon how you feel. Postoperative discomfort
usually does not interrupt sexual activity for more than a few weeks.
How do I pay for a transplant?
The financial coordinator on the transplant team, along with the social
worker, will help you map out a financial plan to cover costs associated
with transplant care, surgery and medication. Patients typically finance
costs associated with their transplant by combining more than one financial
resource. There are several options for those who do not have any type of
health coverage, and there are policies and laws designed to help
transplant patients with special financial needs. The Transplant
Institute's social worker and financial counselor help develop a workable
plan for each patient.
What are my out-of-pocket costs after the transplant?
Out-of-pocket costs following a transplant are highly variable, based on
whether you have insurance or whether you are eligible for Medicare or
Medicaid coverage. We understand that finances are a major concern for
patients, and good planning will help to reduce this stress. Your financial
counselor will review your own unique situation, and help you on an
individual basis address your financial concerns and available resources.
Together we can help you manage the financial impact of your illness,
transplant surgery and long-term recovery.
Whom do I call for more information?
For more information about the Transplant Institute at Beth Israel
Deaconess Medical Center, please call 617-632-9700.
Additional links for frequently asked questions:
United Network for Organ Sharing
New England Organ Bank
The Organ Procurement and Transplantation Network