Pancreas transplant

A pancreas transplant allows patients with type 1 diabetes to get a new source of insulin from a donated pancreas.

Most pancreas transplants are performed on people with type 1 diabetes who also have kidney failure. This means a pancreas transplant is usually performed at the same time as a kidney transplant.

Pancreas transplants are also given to diabetic patients who don’t need a kidney, but who have life-threatening hypoglycaemic attacks.

Hypoglycaemic attacks are a serious complication of diabetes caused by low levels of glucose in the blood. About one in 10 pancreas transplants are carried out for this reason.

Pancreas transplantation is less common than kidney or liver transplantation, and only 200 such transplants are performed in the UK each year with more than 300 people on the waiting list.

The waiting time for a pancreas transplant is between one and two years because there is a shortage of suitable donor organs.

The pancreas and type 1 diabetes

The pancreas is a tadpole-shaped organ, around 10–15cm long that is located in the top half of the abdomen.

The pancreas has two main functions:

• it produces juices which the body uses to digest carbohydrates, fats and proteins
• it produces the hormone insulin which the body needs to break down glucose into energy

In cases of type 1 diabetes the pancreas does not produce any insulin because the insulin-producing cells, the islets, have been destroyed by the patient's own immune system.

Most people with type 1 diabetes are able to control the condition with regular injections of insulin. However, a small number of people go on to develop serious complications despite being given the best available treatment, such as:

• kidney failure – when the kidneys are no longer able to filter waste products from the blood
• diabetic retinopathy – where high levels of glucose in the blood damages the eyes, which can lead to loss of vision 
• diabetic neuropathy – where high sugar levels have damaged the nerves in the hands and feet, meaning that sensation is lost and ulcers can occur
• arterial disease – which affects the arteries to the heart, legs and brain

A pancreas transplant is often combined with a kidney transplant to reduce progression of the complications of diabetes.

Read more about why a pancreas transplant is needed.

What happens during a pancreas transplant

A pancreas transplant can be carried out in three ways:

• Simultaneous Kidney Pancreas Transplant (SPK) – both the pancreas and kidneys are transplanted together, from the same donor. This is the most common type, accounting for nine out of 10 transplants. It is used in people who have kidney disease as a result of type 1 diabetes.
• Pancreas after Kidney Transplant (PAK) – a person first receives a kidney transplant from a living or deceased donor. This is then followed by a pancreas transplant from a deceased donor.
• Pancreas Alone Transplant (PTA) – only the pancreas is transplanted. This is a treatment for patients with very poorly controlled type 1 diabetes who have hypoglycaemic attacks without warning, and which may threaten their life.

Read more about how a pancreas transplant is performed.

Complications

A pancreas transplant is a complicated operation and, like other types of major surgery, there is a risk of complications. 

About one person in five needs further surgery in the first few days after transplantation to deal with problems such as infection and bleeding.

There is also the risk of rejection. This is when the immune system (the body’s defence against infection) thinks the transplanted pancreas is a foreign body and attacks it.

To prevent rejection a type of medication is given to suppress the immune system (immunosuppressants). These need to be taken for the rest of the person's life.

Long-term use of immunosuppressants carries its own risk of complications, such as increased vulnerability to infection and cancer.

Read more about the complications of a pancreas transplant.

Recovery

Having a pancreas transplant places a huge strain on the body and patients are usually in hospital for two to three weeks.

Someone who has had a pancreas transplant can normally carry out their usual activities after a few months.

Read more about recovering from a pancreas transplant.

Outlook

The outlook for people with a pancreas transplant, especially an SPK type of transplant, is relatively good.

• SPK – around 85-90% of pancreases will still be functioning a year after the transplant, and half still functioning over 10 years later
• PAK or PTA – around 80% of pancreases will still be functioning a year after the transplant, and half still functioning five years later

There can be problems with the pancreas after a year, but generally the long-term success rate is good. On average a transplanted pancreas functions properly for 10 years.