Your Pancreas Transplant Information for patients Version 1.1 October 2018 Andrew Sutherland James Gilbert Melanie Phillips Anand Muthusamy
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YourPancreasTransplant
Informationforpatients
Version1.1October2018
AndrewSutherlandJamesGilbert
MelaniePhillipsAnandMuthusamy
Whatispancreastransplantation?
Apancreastransplantisamajorsurgicalproceduretoplaceahealthypancreasfromadeceaseddonorintoapersonwhosepancreasnolongerfunctionsproperly.
Yourpancreasisanorganthatliesbehindthelowerpartofyourstomach(fig1).Oneofitsmainfunctionsistomakeinsulin,ahormonethatregulatestheabsorptionofsugar(glucose)intoyourcells.
Ifyourpancreasdoesn'tmakeenoughinsulinoryourbodyisunabletomakeuseoftheappropriateamountofinsulinmadebyyourpancreas,bloodsugarlevelscanrisetounhealthylevels,resultingindiabetes.
Whatdoesapancreastransplantdo?
Afunctioningpancreastransplantrespondstoyourbloodglucoselevelsbyproducinganappropriatelevelofinsulintomaintainbloodglucoselevelswithinnormalrange.Thismeansyounolongerneedtoinjectyourselfwithinsulinonaday-to-daybasis.However,themainadvantagetoyouisanincreasedlifeexpectancyandlongerkidneytransplantfunction.
Figure1:Anatomicalpositionofthepancreas.
Whocanhaveapancreastransplant?
Diabetescanbebroadlydividedintwotypes:
Type1diabetes:Yourownpancreasdoesnotmakeenoughinsulin,leadingtohighbloodsugars.Thisconditionislesscommonandtypicallyseeninchildrenandyoungadults.
Type2diabetes:Yourbodyisunabletomakeuseoftheappropriateamountofinsulinmadebyyourpancreas.Thisconditionisincreasingrapidlyacrossworld,itisassociatedwithobesityandistypicallyseeninadults.
Pancreastransplantationisusuallyreservedfortreatmentoftype1diabetes,asthetransplantedpancreasresolvestheissueofinsulindeficit.Inselectedcases,pancreastransplantsmayalsobeofferedtotreattype2diabetes.Themajorityofpancreastransplantsaredonecombinedwithakidneytransplantforpeoplewhosekidneyshavebeendamagedbydiabetes(simultaneouspancreaskidneytransplant,SPK).Pancreastransplantalone(PTA)isusuallyreservedfortype1diabeticsthatsufferfromfrequentlifethreateninghypoglycaemiceventsduetoapatient’sinabilitytorespondtolowbloodsugars.
Apancreastransplantcanrestorenormalinsulinproductionandimprovebloodsugarcontrolinpeoplewithdiabetes,butitisnotthestandardtreatmentforallpatientswithdiabetes.Thisprocedureisforselectedpeoplewithdiabeteswhoareconsideredtohavedevelopedorbeatriskofdevelopingcomplicationsduetothediabetes.
Thedecisiontohaveapancreastransplantistakenafterathoroughdiscussionofthepotentialrisksandbenefitsoftheprocedure,andwillbediscussedindetailbythemembersofthetransplantteamduringyourassessment.
Forpeoplewithanyofthefollowing,apancreastransplantmaybeworthconsidering:
Type1Diabetes Type2Diabetes
Kidneydamageduetodiabetes
Consistentlypoorbloodsugarcontroldespiteoptimisedinsulintreatment
ImpairedAwarenessofhypoglycaemia
BodyMassIndex(BMI)oflessthan30andconsistentlypoorbloodsugarcontroldespiteoptimisedinsulintreatment
Whatarethebenefitsofhavingapancreastransplant?
Diabetesaffectsthebloodvesselsofyourbodyandcausesprogressivedamagetovitalorganssuchaskidneys,heart,brain,eyesandnerves.Thisresultsinvariousdamageswhichyoumayalreadyhavebeenadvisedabout,orhavetreatmentfor(kidneydisease,heartattack,retinopathyneedinglaserorsurgerytotheeyes,poorsensationinyourfeet).Sometimeshavinglowbloodsugars(hypoglycemia)withoutanywarningmayputyouatriskofhavingmajorlifethreateningeventifyouareunabletoobtainimmediatemedicalassistance.
Havingasuccessfulpancreastransplantwillreducetheon-goingdamagecausedbythehighlevelsofbloodsugarandoveraperiodofyearswillhelpimprovesomeofthereversibleeffectsofdiabetes.
Asaresult,ifyouhaveasuccessfulpancreastransplantyouarelikelytolivelongerandhavelesschancesoffurtherheartrelatedproblemsorstrokesthatmayaffectyourlifespan.Also,performedasacombinationwithakidneytransplant,youarelikelytohavethekidneytransplantworkmuchlongerifperformedwithapancreasinpeoplewithdiabetes.
Onadaytodaybasis,asuccessfulpancreastransplantwillofferyoutheopportunitytobecompletelyfreeofinsulintreatmentandhavenormalglucosecontrolwithahealthymixeddiet.
Whattypesofpancreastransplantsdoweperform?
Weperformthreedifferenttypesofpancreastransplant:
Simultaneouspancreaskidneytransplant(SPK):Ifyourkidneyshavebeendamagedbydiabetesandyouareondialysisorclosetoneedingdialysis,youwillreceiveapancreasandakidneyduringthesameoperation.Morethantwo-thirdsofpancreastransplantsworldwidearedonesimultaneouslywithakidneytransplant(SPK).
Pancreas-afterkidneytransplant(PAK):Ifyoualreadyhaveafunctioningkidneytransplant,andconsideredtobenefitfromapancreastransplant,youwillreceivethepancreastransplantasaseparateoperation(PAK).
Pancreastransplantalone(PTA):Ifyousufferfromfrequenthypoglycaemicevents,life-threatingcomplicationduetoyourinabilitytorespondtolowbloodsugars(hypoglycaemia),youwillreceiveapancreastransplantalone(PTA)
WhattestswillIneedforassessmentfortransplantation?Aswithallsurgicalproceduresyouwillassessedtomakesurethatyouarefitenoughfortheoperation.Weusuallyaskforyoutohaveascanofyourheartcalledanecho-cardiogramandatraceofyourheartcalledanECG.Youwillalsohavebloodtestresultsandyouwillhaveadetailedhistorytakenofyourdiabetesandanycomplicationsthatyoumayhave.Asmajorityofthecomplicationsoccurringaroundthetimeoftransplantisrelationtotheheartandlungs,youwillhaverigoroustestsoftheseorganfunctions.Thismayinvolveexerciseteststolookatyourheartandlungfunction.Wemayalsoneedsomespecialistteststhatlookatthebloodsupplytoyourheartandthequalityofyourbloodvesselsthatgotoyourlegs.
Whatarethealternativestopancreastransplant?
Islettransplantation:Ifyousufferfromtype1diabeteswithoutkidneyfailureandyouhavefrequenthospitaladmissionsduetoimpairedawarenessofyourhypoglycemiathenyoucouldbeconsideredforisletcelltransplant.Isletcellsareinsulinproducingcellsthatcanberemovedfromadeceaseddonorpancreas.Thesearetheninjectedintoyourliverandcanimproveglucosecontrolandrestoreawarenessofhypoglycaemia.Mostpeoplerequiretwoislettransplantations.Somepeoplebecomeinsulinindependentforalimitedperiodbuttheprimaryaimofisletcelltransplantistorestoreawarenessandreducethenumberofhypoglycaemiaevents.
Simultaneousisletkidneytransplant(SIK):Ifyouhavebeenconsiseredfromsimultaneouspancreaskidneytransplantbuteitheryouorweconsidertherisksofsurgerytobetoogreat,simultaneousisletkidneytransplantmaybeapossibilityforyou.Youwillreceiveisletscellsremovedfromthepancreasofthesamedeceaseddonorthatyoureceivethekidneyfrom.Itislikelyyouwillneedasecondisletcelltransplantafteryourinitialprocedureandalthoughsomepeoplebecomeinsulinindependentforalimitedperiod,theprimaryaimoftheisletcelltransplantistoimprovebloodglucosecontrol,restoreawarenessandreducethenumberofhypoglycaemiaevents.
Kidneytransplantationfromlivingdonor:Ifyouhavediabetesandrenalfailureyoucanalsoconsiderkidneytransplantalonefromalivingdonor.Livingdonorkidneytransplantcanoftenbeagoodoptionespeciallyifyouarenotconsideredfitenoughforasimultaneouspancreasandkidneytransplant.
Kidneytransplantationfromdeceaseddonor:Youcouldopttohaveakidneytransplantationfromadeceaseddonor,eitherduetoyourpersonalpreference,oruponadvicefromthetransplantteamiftherisksrelatingtotheoperationappeartobehigh(afterthoroughassessment).Afurtheroptionifyouarenotconsideredsurgicallyfitforapancreastransplantisasimultaneousisletandkidneytransplant.
Whenyoumeetthetransplantteamyouwillhavetheopportunitytodiscussalternativestopancreastransplant.
Wheredoesadonorpancreascomefrom?
Althoughitispossibleforalivingdonortodonatepartofapancreas,allpancreastransplantsintheUKareobtainedfromdeceaseddonors.Eitherpeoplewhohavesufferedbraindeath,usuallyasaresultofanbraininjury,knownasDonationafterBrainDeath(DBD)orDonationafterCirculatoryDeath(DCD)frompatientswhoaredeclareddeadfollowingabsenceofbreathingorheartbeat.
HowlongwillIwaitfor?
Onceyouareassessedasbeingsuitableforapancreastransplantyouwilljointhenationalwaitinglist.
Unfortunately,itisnotpossibletopredicthowlongyoumayhavetowaitforatransplantandthismostlydependsonthetypeoftransplantyouareexpecting.Itmaybeseveralmonthsorpossiblyyearsbeforeasuitabledonorpancreasbecomesavailable.IntheUK,halfofthepeoplewaitingforapancreastransplantwillhavereceivedoneafterawaitofatleast13months.Thewaitingtimealsodependsonyourbloodgroupandhowlongittakesforasuitabledonorwhosebloodandtissuetypesmatchyourstobecomeavailable.
WhatshouldIdotohelpmyselfwhileIamonthewaitinglist?
Itisimportanttostayashealthyaspossibletoincreaseyourchancesofasuccessfultransplant:
• takeyourmedicationsasprescribed• followyourdietandexerciseguidelines• keepallappointmentswithyourhealthcareteam• stayinvolvedinhealthyactivities,includingthosethatbenefityouremotionalhealth,
suchasrelaxingandspendingtimewithfamilyandfriends.
MakesurethetransplantteamknowshowtoreachyouatalltimesOnceadonorpancreasbecomesavailable,itmustbetransplantedassoonaspossibleandideallywithin12hours.Youshouldkeepapackedhospitalbaghandyandmakearrangementsfortransportationtothetransplantcentreinadvance.Youwillusuallybeabletostayathomeuntilthetransplantteamnotifiesyouthatasuitablepancreasisavailable.Livingwithseverediabetescanbestressfulenoughwithouttheaddedanxietyofwaitingforapancreastobecomeavailable.PleasecontactyourGPorthetransplantcentreforadviceifyouarestrugglingtocopeemotionallywiththedemandsofwaitingforatransplant.Youmayalsofinditusefultocontactasupportgroup,suchasDiabetesUKorDiabetes.co.ukoralocalkidneypatientsassociationifyouarealsowaitingforakidneytransplant.
WhathappenswhenIamcalledin?
Whenanorganbecomesavailableforamemberoftheteamwillphoneyou.Youwillbeaskedaboutyourgeneralhealthandifyouareondialysis,whatmodeofdialysisyouareonandwhenyoulasthaddialysis.Youwillbeaskedtoattendthetransplantunitandyouwillbeadvisedabouteatinganddrinkinginpreparationfortheoperation.Timeisextremelyimportantintransplantationtomaintainthevitalityoftheorgans.Itisveryimportantthatwecancontactyouatalltimes.Thisismostofteninthenight.Whenyoureceivethecallyoumustarriveatthehospitalassoonaspossible-andbyyourownmeansoftransport,ifpossible.Ifyoucannotbecontactedinalimitedtime,theorgansmaybeofferedtoanotherpatient.Unfortunately,itisalsopossiblethatevenonceyouhavebeencalledinthetransplantoperationmaynotgoaheadforavarietyofreasons,usuallyforissuesrelatedtothedonororthepancreasitself.Asthesituationisconstantlyevolvingwithvariouscrucialpiecesofinformationbeingputtogethertoproceedwiththetransplant,thetransplantteamwillkeepyouconstantlyinformed.
Whatisthesurgerylike?
Thisoperationisperformedundergeneralanaesthesia,soyouareunconsciousduringtheprocedure.Theanaesthetistgivesyouananaestheticmedicationasagastobreathethroughamaskandinjectsaliquidmedicationintoyourvein.
Afteryouareunconsciousyouwillhaveoneverticalincisionortwoincisions(cuts)madeinthelowerpartofyourabdomen(stomach)dependingontheconsultantsurgeonandyourtransplantcentre.Thesurgeonplacesthenewpancreasalongwithasmallportionofthedonor’sintestine,usuallyontherightsideofyourlowerabdomen.Thebloodvesselsofthepancreasareconnectedtothebloodvesselsthatsupplybloodtoyourlegsandthedonorintestineisattachedtoyoursmallintestine.Yourownpancreasisleftinplacetosupportdigestion.
Ifyouarealsoreceivingakidneytransplant,thebloodvesselsofthenewkidneywillbeattachedtobloodvesselsinthelowerpartofyourabdomen(stomach),ontheoppositesite,usuallytheleft.
Theureterofthekidneywhichisthetubethatlinksthekidneytothebladder—willbeconnectedtoyourbladder.Unlessyourownkidneysarecausingproblems,suchashighbloodpressureorinfection,theyareleftinplace(fig2).
Pancreastransplantsurgeryusuallylastsaboutthreetofourhours.Simultaneous(doneatthesametime)kidneyandpancreastransplantsurgerytakesafewmorehoursforexamplesixtoeighthours.
Figure2:Thisdrawingshowsthepositionofthenewpancreasandkidneyinthelowerpartofyourabdomen(viewinsidetheabdomenfromthefront).
Whatwillhappenaftertheoperation?
AfterthesurgeryyouwillbemovedintherecoveryareawhereyouwillbemonitoredpriortobeingtransferredtoeithertheHighDependencyUnitorIntensivecare.Whileyouareintherecoveryareayoumayhaveanultrasoundscan.Thisisascanjustlikeapregnantmotherhasusinganultrasoundscanmachine.Thescanisneededtocheckthatthebloodisflowinginandoutoftheneworgan(s).
Onceyouarefullyconsciousfromthegeneralanaesthesia,youwillbeawarethatyouareattachedtoseveraltubes,monitorsandmachines.Thisequipmentwasputintopositionwhileyouwereasleep.
Theymayinclude:
• thePCA:whichisamachinethatdeliverspainkillersthroughatubeintoyourbody,andiscontrolledusingahandhelddevicethatyoucancontrol.It’sfullnameis:patientcontrolledanalgesia(PCA)
• Epidural:Insomecasesyourpainwillbecontrolledbyacatheterwhichisplacedaroundthespinalcordduringyouranaesthetic.
• anoxygenmask• cannulas:tubesthatprovidenutrients(thegoodnessoffood)andfluidintoyourveins• NG(nasalgastric)tube:aplastictubethatgoesthroughyournoseintoyourstomachtokeepyour
stomachempty.Insomecaseyoumayalsohaveafeedingtubeinsertedtohelpwithyournutritionfollowingyourtransplant
• drains:plastictubesthatareplacedtoremovebloodandotherfluidfromtheoperationsite• catheter:atubeinyourbladderthatallowsyoutourinatewithoutgoingtothetoilet(urinary
catheter).• stent:aninternaltubebetweenthebladderandyourtransplantkidney(insimultaneouspancreas
kidneytransplantation)calleda‘stent’toprotectthejoiningwithyoururinarybladder–thiswillneedtoberemovedbyashortprocedureafewweeksafterthetransplant.
ThePCA,whichisforpaincontrolwillberemovedgraduallyduringthefirst48hoursandyouwillhaveotherintravenous(inthevein)ororal(bymouth)painkillerstohelpyouwithanypainyoumayhave.
Youroxygenmaskisrequiredtohelpyourbreathingfor24to48hoursafteryoursurgery.
Theurinarycatheterstaysinplaceforaboutfivedays.Thisissowecanmonitoryoururineoutputandincaseofasimultaneous(doneatthesametime)kidneytransplant,thecatheterhelpstokeepyourbladderemptyandtoprotectthejoiningbetweentheureterandthebladder(ifyouhaveanewtransplantedkidney).Ifyouhaveonlyhadapancreastransplanteitherapancreas-afterkidneytransplant(PAK)orasimultaneouspancreaskidneytransplant(PTA),thecathetermayberemovedonceyouarewellenoughtogotothetoilet;inspecialcircumstanceswherethepancreasglandisdrainingitssecretionstothebladder,youmayneedtohavetheurinecatheteruntiladvisedbythetransplantteam.
Thenasogastrictubehelpstokeepyourstomachemptyor‘decompressed’,untilnormalbowelfunctionreturns.Thishelpstoprotecttheareawhereyournewpancreasisattachedtoyoursmallintestine.Theabdominaldrainsplacedtoremoveanyexcessfluidfromyourabdomen,areusuallyremovedafterfewdaysasyourrecoveryprogresses.Afterfewdays,asyourconditionimprovesandtheplastictubesstarttoberemoved,youwillbemovedtooneoftherenalwards.Duringyourentirehospitalstay,nurses,doctorsandsurgeonswillcloselymonitor(check)yourrecovery.
Everydayyouwillbereviewedonconsultant-ledwardrounds.Nursingstaffwillregularlymeasureyourbloodpressure,pulseandtemperature,bloodsugarlevels(tomonitorifyournewpancreasisworking)andurineoutputseveraltimesaday.Youwillhavedailybloodsamplestakenforanalysisinthelaboratorytoaccuratelycheckonthefunctionofyourneworgan(s),aswellasthedruglevelsofyouranti-rejectionmedication.Youmayreceivesomeinsulinintheearlydaysafteryouroperation.
Duringyourhospitalstayyouwillreceiveafurtherrepeatultrasoundscansand/orCTscansofyournewpancreas.Thesetestslookspecificallyatthebloodflowofyournewpancreas(andkidney,ifrequired)andwillshowupanynarrowingorblockagesofthebloodvessels.
Whattoexpectafteryourtransplant
Youmayexperiencesomepainanddiscomfort,butyouwillhaveaspecialinfusionpump(PCA)attacheddirectlytoaveininthebackofyourhandorarmtogiveyoupainrelievingdrugs.Youcanpressahand-heldbuttonwhenyoufeelpainordiscomfortandthepumpwilldeliverthecorrectpre-programmeddoseofpainkillingdrugsdirectlyintoyourvein..
Itisfairlycommontoexperience“bloating”(inyourtummy)orabdominaldistensioninthefirst48-72hoursaftertheoperation.Thisisduetohavingageneralanaestheticandsurgery.Whenyourbowelstartstorecoveritsfunction,wewilladviseyoutohavetabletpainkillerstohelptogetyoumobileandpainfreeagain.
Youmaygetacough.Havingphysiotherapywillhelptoclearyoursecretionseffectivelyandtopreventchestinfections.
Ifyouhavealsohadakidneytransplant,youmayneedtohavetemporarydialysisjustuntilyournewkidneystartstofunction.
HowlongIwillbeinhospital?
Theaveragepost-transplanthospitalstayisabouttwoweeks.Thisvariesdependingonhowyouarefeelingandifadditionaltestsorinterventionalproceduresarenecessary.Sometimesifspecialmedications,suchasantibioticsareneededtopreventinfectionsyoumayhavetostayinhospitaluntilthetreatmentcourserecommendedhasbeencompleted.
DoIneedfollowupappointments?
Closemonitoringwithfollowupappointmentsisveryimportant.Yourtransplantteamwilldevelopacheck-upschedulethatisrightforyou.However,pleasebepreparedforthefirstfewweekstocomebacktotheclinictwoorthreetimesperweek.Ifyouliveinanothertownyoumayneedtomakearrangementstostayclosetothetransplantcentre.
Ifyouhavehadacombinedkidneyandpancreastransplantyouhadastent(softplastictube)placedintheureter(betweenthekidneyandthebladder).Thiswillneedtoberemovedunderlocalanaestheticfourtoeightweeksafteryourtransplant.
HowlongmightIbeoffwork?
Thisdependsonyourrateofrecoveryfromtheeffectsoftransplant.Inthefirstfewweeksafteryouroperationyouwillneedtoattendclinicappointmentsforuptothreetimesaweekforfollowupappointments.
Also,itisverynormaltohavealittleornoappetite.Youmayalsofeelverytiredonadailybasis.Thiswillimproveasweeksfollowaftertransplantation.Mostpatientscanbeoffworkforaboutthreemonthsandsomeneedevenlonger.Pleasediscussyourprogresswiththetransplantteamwhowillbeveryhappytoadviseyou.
Whatarethecomplicationsoftheoperation?
Pancreastransplantsurgerycarriesariskofcomplicationswhichcanoccurduringand/oraftertheoperation.Theymayincludesomeofthefollowing:
Bleeding
Aswithalloperations,thereisariskofbleeding.Thisismorecommoninpancreastransplantationasanumberofmedicationsandinfusionsaregivenaftertheoperationtokeepthebloodthinandpreventthrombosis(clotting)ofthepancreasgraft.Approximately10percentofpatients(10in100)havesomebleedingaftertransplantationthatmayrequirebloodtransfusionsorareturntotheoperatingroom.
Thrombosis(bloodclot)
Thereisariskofabloodclotforminginthebloodvesselsofthetransplant.Thisiscalledthrombosisandcanoccurin10percentofpatients(10in100).Thisismostlikelyduringthefirstweekafterthetransplantandmayresultintheorganbeingremoved.Youwillbemonitoredverycloselyforsignsofthiswhileyouareinhospitalandwhenyoureturnhome.Youwillhaveregularbloodsamplestakensowecancarryoutspecialclottingteststomeasurehoweffectivelyyourbloodisclottingandtoavoidtheriskofbleeding.
Pancreatitis
Pancreatitisisaninflammationofthepancreas.Acertaindegreeofpancreatitisisinevitable(cannotbeavoided).Thisisduetodamagetothepancreasduringtheprocessofremovalfromthedonor,storageiniceduringtransportationandre-warmingwithyourblood-thisiscalledischemiareperfusioninjury.
Thesymptomsusuallysettlespontaneously(bythemselves)inthemajorityofthetransplantswithinafewdays.Ifthisgraftpancreatitisisnotgettingbetteronitsown,youmayneedtohavefurthersurgerytowashoutanyfluidcollections,oryoumayhavetubesplacedintoyourabdomentodrainthesefluidcollections.Thevastmajorityofpancreatitisgetsbetteronitsown,butapproximatelyfiveto10percentofpatients(fiveto10in100),mayneedthetransplantedpancreastoberemoved.
Furtheroperations
Approximatelyoneoutofeveryfivepeoplewhohaveapancreastransplantwillneedtogobacktooperatingtheatreforafurtherproceduretodealwithanyoftheabovecomplicationsshouldtheyoccur.
Othercomplications
Thegeneralrisksaresimilartothosefollowinganytypeofmajorabdominalsurgery,includingwoundinfection,infectioninsidetheabdomen,cardiac(heart)complications,deepveinthrombosis(bloodclotsinthelegs)andpulmonaryembolism(bloodclotswhichmovetothelungs).
DoIneedtotakemedications?
Yeswillneedtotakedrugscalledimmunosuppressives.Thesehelptokeepyourimmunesystemfromattackingyourneworgan(s).Stoppingorirregularintakeofthesemedicationswillinevitablyleadtotransplantlossandseriousproblemsforyourhealth.Moredrugsmaybegiventohelpreducetheriskofothercomplicationssuchasinfectionandhighbloodpressure,afteryourtransplant.Onceyouarecomfortableaftertheoperationyouwillbegintolearnaboutyournewmedications.Thedrugswillbelistedonamedicationrecordcardandthepharmacistwillseeyoutoexplainwhattheydoandhowtotakethem.Youwillthenstarttotakeyourmedicationsyourselfcloselysupervised(monitored)bythenursingstaff.Onceyouareconfidentwithtakingyournewmedicationsyouwillbeabletotakeyourmedicationsunsupervised,asyouwoulddoathome.Thistrainingaimstohelpyoubecomefamiliarandconfidentwithtakingallyournewmedicationsbeforeyougohome.
Complicationsofimmunosuppression
Intheearlydaysfollowingatransplant,thesurgeryandtheimmunosuppressiondrugsmakeyourbodymorevulnerabletochest,urinaryandothertypesofinfections.Youwillbegivenantibioticsandanti-viraldrugstohelppreventandtreatanyactiveinfection.
Rejection
Yourbody’snaturalimmuneresponseistotryandgetridoftheneworgan(s),byorganisingaplannedresponseagainstthedonor’scells.Immunosuppressionmedicationshelptocontrolthisresponse.However,despitetheimmunosuppressionmedications,rejectiondoesoccurinaboutoneinfourtransplants.Rejectioncanaffectthepancreasorthekidney,orbothorgansatthesametime.Itisimportanttoidentifysignsorsymptomsofrejectionearlysoeffectivetreatmentcanbegiven.Thisisusuallydonebygivingadditionalimmunosuppressionmedications.
Tofindoutwhetheryourbodyisrejectingtheorganyoumayneedabiopsyofthetransplantedorgan(s).Thismeansasampleoftheorganiscollectedusingalongneedle.Thisisdoneusinglocalanaesthetic(toreduceanydiscomfortforyou),whichnumbstheareawheretheneedleisinserted.
WhatdrugsdoIneedtotake?
Toprotectyourtransplantedpancreas(andkidney,ifthathasbeentransplantedtoo)fromrejectionbyyourimmunesystemyouwillneedtotakepowerfulmedicationscalledimmunosuppressiondrugs.Thedoseoftheimmunosuppressionmedicationswillbeprogressivelyreducedfollowingyourtransplant,butifyouweretostoptakingtheimmunosuppressivemedicationsyournewpancreas(andkidney,iftransplanted)wouldstopworkingandwouldberejectedbyyourbody.
Atthetimeofyouroperation,youwillreceiveaninjectionofadrugthatreducestheabilityofyourimmunesystemtorejectyourtransplantedorgans.Thisisfollowedbylong-termdrugtherapymostcommonlywithacombinationoftwodifferenttypesoftabletmedications,Tacrolimus(Adoport)andMycophenolatemofetil(MMF).Youmaybegivenadditionalmedicationssuchastabletsteroidsifthereisconcernregardinggraftrejectionorintolerancetoanyoftheotherimmunosuppressionmedications.
Whatarethesideeffectsofthesemedications?
Aswithallmedications,theanti-rejectionmedicationscancauseavarietyofsideeffects.However,itisimportanttorememberthatyoumaynotexperiencealloranyofthese.Themostcommonarelistedbelow.
Tacrolimus(Adoport)–immunosuppressionmedication
·tremor(shakyhands)
·upsetstomach(usuallyinearlyperiodoftreatment,normallyresolves)
·sleepdisturbances
·increaseinbloodpressure
·increaseinbloodsugar(diabetes)usuallywithhighbloodconcentrationofthedrug
·hairloss
·moodchanges
·headaches
Mycophenolatemofetil(MMF)–immunosuppressionmedication
·reductioninyourwhitebloodcellcount(andtheconsequentriskofinfection)
·upsetstomachincludingdiarrhoea,nauseaandvomiting
·riskofbirthdefects(discussthisindetailwiththetransplantpharmacistifyouoryourpartnerareplanningongettingpregnant).
Whataretherisksofthelong-termimmunosuppressivemedications?
Astheanti-rejectionmedicationssuppressyourimmunesystemyouwillbeatgreaterriskofinfections.Theseinfectionscanpotentiallybecomelifethreateningasyourbodyisnotabletoprovideitsusualresponsetoinfectionwhileyourimmunesystemislowered.Youaremostvulnerableforthefirstthreetosixmonthsafteryourtransplant.Youwillbeonpreventativedosesofmedicationsagainstcommoninfectionsthatoccuraftertransplantation,thesemedicationswillbegraduallywithdrawnastheriskreduces.Long-termimmunosuppressionmedicationincreasestheriskofyoudevelopingsomeformsofcancer,relatingtoyourskinorlymphglands(lymphoma).Wewillmonitoryoucloselyforanysignsofthesecancersafteryourtransplant,astheycanusuallybeeffectivelytreatediffoundearly.Wewillalsogiveyouadviceaboutskincareprotection-includingsunprotection.
Whathappensifthepancreastransplantfails?
Ifyournewpancreasfails,youcanresumeinsulintreatmentsandconsiderasecondtransplant.Thisdecisionwilldependonyourcurrenthealth,yourabilitytowithstandsurgeryandyourexpectationsformaintainingacertainqualityoflife.
Howsuccessfulispancreastransplantation?
Successratesoftransplantsareusuallyreportedintwoways:
Patientsurvival:thepercentageofpatientswhoarealiveaftertransplant.Itisusuallymeasuredatoneandfiveyearsaftertransplant.
Graftsurvival:thepercentageofthetransplantedorgansstillfunctioning.Itisusuallymeasuredatoneandfiveyearsaftertransplant.
IntheUKthepatientsurvivalatoneyearandfiveyearsafterpancreastransplantis97percentand89percentrespectively.Inotherwords,afterapancreastransplant97outof100patientsarestillaliveatoneyearandmorethan89outof100patientsatfiveyears.
InSPK(simultaneouspancreaskidneytransplants)thepancreasgraftsurvivalatoneyearandfiveyearsis88percentand78percent,respectively.Inotherwords,afterSPK,88outof100pancreaseswillstillbefunctioningatoneyearand78outof100pancreasesafterfiveyears.
InPTA(pancreastransplantalone–wherethereisnokidneytransplanted),thepancreasgraftsurvivalatoneandfiveyearsis80percentand53percent,respectively.Inotherwords,afterPTA,80outof100pancreaseswillbestillfunctioningatoneyearand53outof100pancreasesafterfiveyears.
Version1.1October2018AndrewSutherland
JamesGilbertMelaniePhillips
AnandMuthusamy
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