Your Pancreas Transplant...Simultaneous pancreas kidney transplant (SPK): If your kidneys have been...
Transcript of Your Pancreas Transplant...Simultaneous pancreas kidney transplant (SPK): If your kidneys have been...
YourPancreasTransplant
Informationforpatients
Version1.2April2019
AndrewSutherlandJamesGilbert
MelaniePhillipsAnandMuthusamy
Whatispancreastransplantation?
Apancreastransplantisamajorsurgicalproceduretoplaceahealthypancreasfromadeceaseddonorintoapersonwhosehasdiabetes.
Yourpancreasisanorganthatliesbehindthelowerpartofyourstomach(fig1).Oneofitsmainfunctionsistomakeinsulin,ahormonethatregulatestheabsorptionofsugar(glucose)intoyourcells.
Ifyourpancreasdoesn'tmakeenoughinsulinoryourbodyisunabletomakeuseoftheappropriateamountofinsulinmadebyyourpancreas,bloodsugarlevelscanrisetounhealthylevels,resultingindiabetes.
Whatdoesapancreastransplantdo?
Afunctioningpancreastransplantrespondstoyourbloodglucoselevelsbyproducinganappropriatelevelofinsulintomaintainbloodglucoselevelswithinnormalrange.Thismeansyounolongerneedtoinjectyourselfwithinsulinonaday-to-daybasis.However,themainadvantagetoyoucanbeincreasedlifeexpectancyandlongerkidneytransplantfunction.
Figure1:Anatomicalpositionofthepancreas.
Whocanhaveapancreastransplant?
Diabetescanbebroadlydividedintwotypes:
Type1diabetes:Yourownpancreasdoesnotmakeenoughinsulin,leadingtohighbloodsugars.Thisconditionislesscommonandtypicallyseeninchildrenandyoungadults.
Type2diabetes:Yourbodyisunabletomakeuseoftheappropriateamountofinsulinmadebyyourpancreas.Thisconditionisincreasingrapidlyacrosstheworld,itisassociatedwithobesityandistypicallyseeninadults.
Pancreastransplantationisusuallyreservedfortreatmentoftype1diabetes.Inselectedcases,pancreastransplantsmayalsobeofferedtotreattype2diabetesiftheirBodyMassIndexislessthan30.Themajorityofpancreastransplantsaredonecombinedwithakidneytransplantforpeoplewhosekidneyshavebeendamagedbydiabetes(simultaneouspancreaskidneytransplant,SPK).Pancreastransplantalone(PTA)isusuallyreservedfortype1diabeticsthatsufferfromfrequentlifethreateninghypoglycaemiceventsduetoaninabilitytorespondtolowbloodsugars.
Apancreastransplantcanrestorenormalinsulinproductionandimprovebloodsugarcontrolinpeoplewithdiabetes,butitisnotthestandardtreatmentforallpatientswithdiabetes.Thisprocedureisforselectedpeoplewithdiabeteswhoareconsideredtohavedevelopedorbeatriskofdevelopingcomplicationsduetothediabetes.
Thedecisiontohaveapancreastransplantistakenafterathoroughdiscussionofthepotentialrisksandbenefitsoftheprocedure,andwillbediscussedindetailbythemembersofthetransplantteamduringyourassessment.
Whatarethebenefitsofhavingapancreastransplant?
Diabetesaffectsthebloodvesselsofyourbodyandcausesprogressivedamagetovitalorganssuchaskidneys,heart,brain,eyesandnerves.Thisresultsinvariousdamageswhichyoumayalreadyhavebeenadvisedabout,orhavetreatmentfor(kidneydisease,heartattack,retinopathyneedinglaserorsurgerytotheeyes,poorsensationinyourfeet).Sometimeshavinglowbloodsugars(hypoglycemia)withoutanywarningmayputyouatriskofhavingamajorlifethreateningeventifyouareunabletoobtainimmediatemedicalassistance.
Havingasuccessfulpancreastransplantwillreducetheon-goingdamagecausedbythehighlevelsofbloodsugarandoveraperiodofyearsmayhelpimprovesomeofthereversibleeffectsofdiabetes.
Asaresult,ifyouhaveasuccessfulpancreastransplantyouarelikelytolivelongerandhavelesschancesoffurtherheartrelatedproblemsorstrokesthatmayaffectyourlifespan.Also,performedasacombinationwithakidneytransplant,thekidneytransplantislikelytoworklonger.
Onadaytodaybasis,asuccessfulpancreastransplantwillofferyoutheopportunitytobecompletelyfreeofinsulintreatmentandhavenormalglucosecontrolwithahealthymixeddiet.
Whattypesofpancreastransplantsdoweperform?
Weperformthreedifferenttypesofpancreastransplant:
Simultaneouspancreaskidneytransplant(SPK):Ifyourkidneyshavebeendamagedbydiabetesandyouareondialysisorclosetoneedingdialysis,youcanreceiveapancreasandakidneyduringthesameoperation.Morethantwo-thirdsofpancreastransplantsworldwidearedonesimultaneouslywithakidneytransplant(SPK).
Pancreas-afterkidneytransplant(PAK):Ifyoualreadyhaveafunctioningkidneytransplant,anditisconsideredyoumaybenefitfromasubsequentpancreastransplant.
Pancreastransplantalone(PTA):Ifyousufferfromfrequentlife-threateninghypoglycaemicevents,youcanbeconsideredforapancreastransplantalone(PTA)
WhattestswillIneedforassessmentfortransplantation?Aswithallsurgicalproceduresyouwillbeassessedtomakesurethatyouarefitenoughfortheoperation.Weusuallyaskforyoutohaveascanofyourheartcalledanecho-cardiogramandatraceofyourheartcalledanECG.Youwillalsohavebloodtestresultsandyouwillhaveadetailedhistorytakenofyourdiabetesandanycomplicationsthatyoumayhave.Asthemajorityofthecomplicationsoccuraroundthetimeoftransplantandarerelatedtotheheartandlungs,youwillhaverigoroustestsoftheseorganfunctions.Thismayinvolveexerciseteststolookatyourheartandlungfunction.Wemayalsoneedsomespecialistteststhatlookatthebloodsupplytoyourheartandthequalityofyourbloodvesselsthatgotoyourlegs.
Whatarethealternativestopancreastransplant?
Optimisationofmedicaltreatment:Yourdiabeticteamwillaimtooptimizeyourdiabeticmanagement,improvingbloodsugarcontrolandreducinghypoglycaemicevents.
Islettransplantation:Ifyousufferfromtype1diabeteswithoutkidneyfailureandyouhavefrequenthospitaladmissionsduetoimpairedawarenessofyourhypoglycemiathenyoucouldbeconsideredforisletcelltransplant.Isletcellsareinsulinproducingcellsthatcanberemovedfromadeceaseddonorpancreas.Thesearetheninjectedintoyourliverandcanimproveglucosecontrolandrestoreawarenessofhypoglycaemia.Mostpeoplerequiretwoislettransplantations.Somepeoplebecomeinsulinindependentforalimitedperiodbuttheprimaryaimofisletcelltransplantistorestoreawarenessandreducethenumberofhypoglycaemiaevents.
Simultaneousisletkidneytransplant(SIK):Ifyouhavebeenconsideredfromsimultaneouspancreaskidneytransplantbuteitheryouorweconsidertherisksofsurgerytobetoogreat,simultaneousisletkidneytransplantmaybeapossibilityforyou.Youwillreceiveisletscellsremovedfromthepancreasofthesamedeceaseddonorthatyoureceiveakidneyfrom.Itislikelyyouwillneedasecondisletcelltransplantafteryourinitialprocedureandalthoughsomepeoplebecomeinsulinindependentforalimitedperiod,theprimaryaimoftheisletcelltransplantistoimprovebloodglucosecontrolandrestoreawarenessofhypoglycaemia.
Kidneytransplantationfromlivingdonor:Ifyouhavediabetesandrenalfailureyoucanalsoconsiderkidneytransplantalonefromalivingdonor.Livingdonorkidneytransplantcanoftenbeagoodoptionespeciallyifyouarenotconsideredfitenoughforasimultaneouspancreasandkidneytransplant.AnumberofstudieshaveshownthatlifeexpectancycanbesimilarinType1diabeticswithrenalfailurewhohavealivingdonorkidneytransplantcomparedtothosethathaveaSimultaneousKidneyPancreastransplant.Thisisespeciallythecaseinolderpatients.
Kidneytransplantationfromdeceaseddonor:Youcouldopttohaveakidneytransplantationfromadeceaseddonor,eitherduetoyourpersonalpreference,oruponadvicefromthetransplantteamiftherisksrelatingtotheoperationappeartobehigh(afterthoroughassessment).
Whenyoumeetthetransplantteamyouwillhavetheopportunitytodiscussalternativestopancreastransplant.
Wheredoesadonorpancreascomefrom?
Althoughitispossibleforalivingdonortodonatepartofapancreas,allpancreastransplantsintheUKareobtainedfromdeceaseddonors.Eitherpeoplewhohavesufferedbraindeath,usuallyasaresultofanbraininjury,knownasDonationafterBrainDeath(DBD)orDonationafterCirculatoryDeath(DCD)frompatientswhoaredeclareddeadfollowingabsenceofbreathingorheartbeat.
HowlongwillIwaitfor?
Onceyouareassessedasbeingsuitableforapancreastransplantyouwilljointhenationalwaitinglist.Unfortunately,itisnotpossibletopredicthowlongyoumayhavetowaitforatransplantandthismostlydependsonthetypeoftransplantyouareexpecting.Itmaybeseveralmonthsorpossiblyyearsbeforeasuitabledonorpancreasbecomesavailable.IntheUK,halfofthepeoplewaitingforapancreastransplantwillhavereceivedoneafteratleast13months.Thewaitingtimealsodependsonyourbloodgroupandhowlongittakesforasuitabledonorwhosebloodandtissuetypesmatchyourstobecomeavailable.
WhatshouldIdotohelpmyselfwhileIamonthewaitinglist?
Itisimportanttostayashealthyaspossibletoincreaseyourchancesofasuccessfultransplant:
• takeyourmedicationsasprescribed• followyourdietandexerciseguidelines• keepallappointmentswithyourhealthcareteam• stayinvolvedinhealthyactivities,includingthosethatbenefityouremotionalhealth,
suchasrelaxingandspendingtimewithfamilyandfriends.
MakesurethetransplantteamknowshowtoreachyouatalltimesOnceadonorpancreasbecomesavailable,itmustbetransplantedassoonaspossibleandideallywithin12hours.Youshouldkeepapackedhospitalbaghandyandmakearrangementsfortransportationtothetransplantcentreinadvance.Youwillusuallybeabletostayathomeuntilthetransplantteamnotifiesyouthatasuitablepancreasisavailable.Livingwithseverediabetescanbestressfulenoughwithouttheaddedanxietyofwaitingforapancreastobecomeavailable.PleasecontactyourGPorthetransplantcentreforadviceifyouarestrugglingtocopeemotionallywiththedemandsofwaitingforatransplant.Youmayalsofinditusefultocontactasupportgroup,suchasDiabetesUKorDiabetes.co.ukoralocalkidneypatientsassociationifyouarealsowaitingforakidneytransplant.
WhathappenswhenIamcalledin?
Whenanorganbecomesavailableamemberoftheteamwillphoneyou.Youwillbeaskedaboutyourgeneralhealthandifyouareondialysis,whatmodeofdialysisyouareonandwhenyoulasthaddialysis.Youwillbeaskedtoattendthetransplantunitandyouwillbeadvisedabouteatinganddrinkinginpreparationfortheoperation.Timeisextremelyimportantintransplantationtomaintaintheviabilityoftheorgans.Itisveryimportantthatwecancontactyouatalltimes.Thisismostofteninthenight.Whenyoureceivethecallyoumustarriveatthehospitalassoonaspossible-andbyyourownmeansoftransport,ifpossible.Ifyoucannotbecontactedinalimitedtime,theorgansmaybeofferedtoanotherpatient.Unfortunately,itisalsopossiblethatevenonceyouhavebeencalledin,thetransplantoperationmaynotgoaheadforavarietyofreasons,usuallyforissuesrelatedtothedonororthepancreasitself.Asthesituationisconstantlyevolvingwithvariouscrucialpiecesofinformationbeingputtogethertoproceedwiththetransplant,thetransplantteamwillkeepyouconstantlyinformed.
Whatisthesurgerylike?
Thisoperationisperformedundergeneralanaesthesia,soyouareunconsciousduringtheprocedure.Youwillhaveoneverticalincisionortwoincisions(cuts)madeinthelowerpartofyourabdomendependingontheconsultantsurgeonandyourtransplantcentre.Thesurgeonplacesthenewpancreasalongwithasmallportionofthedonor’sintestine,usuallyontherightsideofyourlowerabdomen.Thebloodvesselsofthepancreasareconnectedtothebloodvesselsthatsupplybloodtoyourlegsandthedonorintestineisattachedtoyoursmallintestine(figure2).Yourownpancreasisleftinplace.
Figure2:Thisdrawingshowsthepositionofthenewpancreasandkidneyinthelowerpartofyourabdomen(viewinsidetheabdomenfromthefront).
Ifyouarealsoreceivingakidneytransplant,thebloodvesselsofthenewkidneywillbeattachedtobloodvesselsinthelowerpartofyourabdomen,ontheoppositesite,usuallytheleft.Theureterofthekidneywhichisthetubethatlinksthekidneytothebladder—willbeconnectedtoyourbladder.Unlessyourownkidneysarecausingproblems,suchashighbloodpressureorinfection,theyareleftinplace.
Pancreastransplantsurgeryusuallylastsaboutthreetofourhours.Simultaneouskidneyandpancreastransplantsurgerylastsabout5to7hours.
Whatwillhappenaftertheoperation?
AfterthesurgeryyouwillbemovedtotherecoveryareawhereyouwillbemonitoredpriortobeingtransferredtoeithertheHighDependencyUnitorIntensivecare.Onceyouarefullyconsciousfromthegeneralanaesthesia,youwillbeawarethatyouareattachedtoseveraltubes,monitorsandmachines.Thisequipmentwasputintopositionwhileyouwereasleep.
Theymayinclude:
• PCA(PatientControlledAnalgesia):whichisamachinethatdeliverspainkillersthroughatubeintoyourbody,andiscontrolledusingahandhelddevicethatyoucancontrol.
• 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.
ThePCAwillberemovedgraduallyduringthefirst48hoursandyouwillhaveotherintravenous(inthevein)ororal(bymouth)painkillerstohelpyouwithanypainyoumayhave.
Youroxygenmaskisrequiredtohelpyourbreathingfor24to48hoursafteryoursurgery.
Theurinarycatheterstaysinplaceforaboutfivedays.Thisissowecanmonitoryoururineoutputandincaseofasimultaneouskidneytransplant,thecatheterhelpstokeepyourbladderemptyandtoprotectthejoiningbetweentheureterandthebladder(ifyouhaveanewtransplantedkidney).Ifyouhaveonlyhadapancreastransplantthecathetermayberemovedonceyouarewellenoughtogotothetoilet;inspecialcircumstanceswherethepancreasisdrainingitssecretionstothebladder,youmayneedtohavetheurinecatheteruntiladvisedbythetransplantteam.
Thenasogastrictubehelpstokeepyourstomachemptyor‘decompressed’,untilnormalbowelfunctionreturns.Thishelpstoprotecttheareawhereyournewpancreasisattachedtoyoursmallintestine.Theabdominaldrainsplacedtoremoveanyexcessfluidfromyourabdomen,areusuallyremovedafterfew
daysasyourrecoveryprogresses.Whenyourconditionimprovesandtheplastictubesstarttoberemoved,youwillbemovedtooneofthewards.Duringyourentirehospitalstay,nurses,doctorsandsurgeonswillcloselymonitoryourrecovery.
Everydayyouwillbereviewedonwardrounds.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”orabdominaldistensioninthefirst48-72hoursaftertheoperation.Thisisduetothebowelsbeingslowtostartworkingafterhavingageneralanaestheticandsurgery.
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,itisverynormaltohavelittleornoappetite.Youmayalsofeelverytiredonadailybasis.Thiswillimproveasweeksfollowaftertransplantation.Mostpatientscanbeoffworkforaboutthreemonthsandsomeneedevenlonger.Pleasediscussyourprogresswiththetransplantteamwhowillbeveryhappytoadviseyou.
Whatarethecomplicationsoftheoperation?
Pancreastransplantsurgerycarriesariskofcomplicationswhichcanoccurduringand/oraftertheoperation.Theymayincludesomeofthefollowing:
Bleeding
Aswithalloperations,thereisariskofbleeding.Thisismorecommoninpancreastransplantationasanumberofmedicationsandinfusionsaregivenaftertheoperationtokeepthebloodthinandpreventthrombosis(clotting)ofthepancreas.Approximately10percentofpatients(10in100)havesomebleedingaftertransplantationthatmayrequirebloodtransfusionsorareturntotheoperatingroom.
Thrombosis(bloodclot)
Thereisariskofabloodclotforminginthebloodvesselsofthetransplant.Thisiscalledthrombosisandcanoccurin10percentofpatients(10in100).Thisismostlikelyduringthefirstweekafterthetransplantandmayresultintheorganbeingremoved.Youwillbemonitoredverycloselyforsignsofthiswhileyouareinhospitalandwhenyoureturnhome.Youwillhaveregularbloodsamplestakensowecancarryoutspecialclottingteststomeasurehoweffectivelyyourbloodisclottingandtoavoidtheriskofbleeding.
Pancreatitis
Pancreatitisisaninflammationofthepancreas.Acertaindegreeofpancreatitisisinevitable(cannotbeavoided).Thisisduetodamagetothepancreasduringtheprocessofremovalfromthedonor,storageiniceduringtransportationandre-warmingwithyourblood-thisiscalledischemiareperfusioninjury.
Thesymptomsusuallysettlespontaneously(bythemselves)inthemajorityofthetransplantswithinafewdays.Thevastmajorityofpancreatitisgetsbetteronitsown,butapproximatelyfiveto10percentofpatients(fiveto10in100),mayneedthetransplantedpancreastoberemoved.
Furtheroperations
Approximatelyoneoutofeveryfivepeoplewhohaveapancreastransplantwillneedtogobacktooperatingtheatreforafurtherproceduretodealwithanyoftheabovecomplicationsshouldtheyoccur.
KidneyTransplantcomplicationsIfyoureceiveasimultaneouskidneypancreastransplanttherearesomerisksspecificallyrelatedtothekidneytransplant.Upto40percent(40in100)ofkidneyscandevelopdelayedgraftfunction(DGF),whenthekidneydoesnotworkimmediately.Thisusuallyrecoversbutcanupto1to2weeksandwilloftenrequireakidneybiopsy.Itisrare(lessthan1percent,1in100)forkidneytonotworkatallfromtheoutset.Therecanalsobecomplicationsrelatedtothejoinbetweentheureterandthebladder(eitheraurineleak,oranarrowingor‘stricture’ofthejoin).Thisoccursinlessthan2percentofpatients(2in100).Othercomplications
Thegeneralrisksaresimilartothosefollowinganytypeofmajorabdominalsurgery,includingwoundinfection,infectioninsidetheabdomen,cardiac(heart)complications,deepveinthrombosis(bloodclotsinthelegs)andpulmonaryembolism(bloodclotswhichmovetothelungs).
DoIneedtotakemedications?
Yeswillneedtotakedrugscalledimmunosuppressives(anti-rejectiondrugs).Thesehelptokeepyourimmunesystemfromattackingyourneworgan(s).Stoppingorirregularintakeofthesemedicationswillinevitablyleadtotransplantlossandseriousproblemsforyourhealth.Moredrugsmaybegiventohelpreducetheriskofothercomplicationssuchasinfectionandhighbloodpressure,afteryourtransplant.Onceyouarecomfortableaftertheoperationyouwillbegintolearnaboutyournewmedications.Thedrugswillbelistedonamedicationrecordcardandthepharmacistwillseeyoutoexplainwhattheydoandhowtotakethem.Youwillthenstarttotakeyourmedicationsyourselfcloselysupervised(monitored)bythenursingstaff.Onceyouareconfidentwithtakingyournewmedicationsyouwillbeabletotakeyourmedicationsunsupervisedasyouwoulddoathome.
Complicationsofimmunosuppression
Intheearlydaysfollowingatransplant,thesurgeryandtheimmunosuppressiondrugsmakeyourbodymorevulnerabletochest,urinaryandothertypesofinfections.Youwillbegivenantibioticsandanti-viraldrugstohelppreventandtreatanyactiveinfection.
Rejection
Yourbody’snaturalimmuneresponseistotryandgetridoftheneworgan(s),byorganisingaplannedresponseagainstthedonor’scells.Immunosuppressionmedicationshelptocontrolthisresponse.However,despitetheimmunosuppressionmedications,rejectiondoesoccurinuptooneinfourtransplants.Rejectioncanaffectthepancreasorthekidney,orbothorgansatthesametime.Itisimportanttoidentifysignsorsymptomsofrejectionearlysoeffectivetreatmentcanbegiven.Thisisusuallydonebygivingadditionalimmunosuppressionmedications.
Tofindoutwhetheryourbodyisrejectingtheorganyoumayneedabiopsyofthetransplantedorgan(s).Thismeansasampleoftheorganiscollectedusingalongneedle.Thisisdoneusinglocalanaesthetic(toreduceanydiscomfortforyou),whichnumbstheareawheretheneedleisinserted.
WhatdrugsdoIneedtotake?
Toprotectyourtransplantedpancreas(andkidney,ifthathasbeentransplantedtoo)fromrejectionbyyourimmunesystemyouwillneedtotakepowerfulmedicationscalledimmunosuppressiondrugs.Thedoseoftheimmunosuppressionmedicationswillbeprogressivelyreducedfollowingyourtransplant,butifyouweretostoptakingtheimmunosuppressivemedicationsyournewpancreas(andkidney,iftransplanted)wouldstopworkingandwouldberejectedbyyourbody.
Atthetimeofyouroperation,youwillreceiveaninjectionofadrugthatreducestheabilityofyourimmunesystemtorejectyourtransplantedorgans.Thisisfollowedbylong-termdrugtherapymostcommonlywithacombinationoftwodifferenttypesoftabletmedications,TacrolimusandMycophenolatemofetil(MMF).Youmaybegivenadditionalmedicationssuchassteroidsifthereisconcernregardinggraftrejectionorintolerancetoanyoftheotherimmunosuppressionmedications.Thedoseoftheimmunosuppressionmedicationswillbeprogressivelyreducedfollowingyourtransplant,butifyouweretostoptakingtheimmunosuppressivemedicationsyournewpancreas(andkidney,iftransplanted)wouldstopworkingandwouldberejectedbyyourbody.
Whatarethesideeffectsofthesemedications?
Aswithallmedications,theanti-rejectionmedicationscancauseavarietyofsideeffects.However,itisimportanttorememberthatyoumaynotexperiencealloranyofthese.Themostcommonanti-rejectiondrugsandpotentialsideeffectsarelistedbelow:
Tacrolimus
·tremor(shakyhands)
·upsetstomach(usuallyinearlyperiodoftreatment,normallyresolves)
·sleepdisturbances
·increaseinbloodpressure
·increaseinbloodsugar(diabetes)usuallywithhighbloodconcentrationofthedrug
·hairloss
·moodchanges
·headaches
·kidneydamage(especiallyathighlevelsoftacrolimus)
Mycophenolatemofetil(MMF)
·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.
Version1.2April2019
AndrewSutherlandJamesGilbert
MelaniePhillipsAnandMuthusamy