Pancreas transplant - Complications of a pancreas transplant

A pancreas transplant is a complex operation and, as with other types of major surgery, there is a risk of complications.

Complications following pancreas transplants are common. About one person in five needs further surgery to deal with problems such as infection and bleeding.

Other potential complications are described below.

Rejection of the pancreas

Rejection is a normal reaction of the body. When a new organ is transplanted, your body’s immune system sees it as a threat, and attacks it in the way it would attack any foreign organism, such as bacteria or a virus.

To reduce the immune system's response, immunosuppressant medications are given and must be taken for life.

The rejection rate of pancreas transplants is lower in older people. The risk of developing complications after the procedure is higher in people who are over 50 years old.

Signs that could indicate a rejection include:

• tenderness, pain and swelling of the new organ
• decreased urine output if you have a kidney transplant at the same time
• high temperature (fever) of 38C (100.4F) or above
• abdominal pain
• being sick (vomiting)
• increase in blood glucose level
• sudden increase in weight
• flu-like symptoms
• ankle swelling
• shortness of breath
• any areas that are red, warm to touch or have a discharge

If you have any of these symptoms, contact a member of your transplant team immediately.

Rejection is usually treated by increasing the dosage of your immunosuppressants.

Other complications

Some other possible complications of a pancreas transplant are outlined below.

Blood clots (thrombosis)

Thrombosis is a blood clot in one of the deep veins in the body. It is an early complication that often occurs within 24 hours of a pancreas transplant.

A thrombosis in one of your own veins can be treated with medication designed to thin the blood.

A thrombosis in the transplanted pancreas itself usually results in it failing and being removed.

Pancreatitis

Pancreatitis is inflammation (swelling) of the pancreas and is common in the first few days after surgery.

Symptoms of pancreatitis include:

• a dull pain in your abdomen
• nausea (feeling sick)
• vomiting

Pancreatitis should pass within a few days.

Eye disease

Most patients notice their vision gets worse in the first three months after a pancreas transplant, and then it starts to improve after this time. If patients are on steroids as part of their immunosuppressant treatment any pre-existing cataracts may get worse following a pancreas transplant.

Fluid retention

Fluid retention (oedema) is more likely to occur for several days after a simultaneous kidney and pancreas transplant (SPK).

This can cause swelling of your feet and ankles.

Urine leakage

Sometimes urine can leak as a result of a breakdown in some of the transplanted tissue. It usually occurs during the first two or three months after the transplant. Surgery to repair the leak will usually be required.

Infections

Following a pancreas transplant, a number of different infections can occur, such as:

• urinary tract infections 
• viral infections, such as cytomegalovirus
• fungal infections, such as thrush

Antibiotic, antiviral or antifungal medications can be used to treat infections.

Abdominal abscess

An abdominal abscess is a serious complication that can occur one to six months after the surgery. Symptoms include abdominal pain and a high temperature (fever).

A computerised tomography (CT) scan will often be used to determine whether an abdominal abscess is present.

They can be treated using a combination of antibiotics and surgery to drain away the pus.

Death

As with all major surgery, there is a risk (between two and five in 100) of dying in the first year after a pancreas transplant, from a complication such as an infection, heart attack or stroke. However, your chances of being alive 10 years later are much higher following a successful pancreas transplant.

Immunosuppressants

Taking immunosuppressants following a transplant carries its own risks.

You will have to take a dose high enough to prevent your immune system rejecting the pancreas, but not so high your body is unable to fight off infection.

Finding the right dose can be difficult, and it may take months to find the most effective dose that causes the fewest side effects.

Two widely used immunosuppressants are:

• tacrolimus
• mycophenolate

Side effects that you may have while taking immunosuppressants include:

• an increased risk of developing infection and cancer
• shaking of the hands
• weight gain
• mood swings
• diarrhoea or abdominal pains
• hair thinning
• thinning of the bones (osteoporosis)
• muscle weakness
• feeling sick
• being sick
• stomach ulcers 
• blurred vision
• insomnia 
• acne 

Most of these side effects start to improve once the right dose of immunosuppressants has been identified. However, even if your side effects become very troublesome, you should never suddenly stop taking your medication. If you do, your pancreas could be rejected.