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Pancreatic Failure and Transplant

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What is Pancreatic Failure?

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The pancreas is a small organ connected to the small bowel. It has two vital roles - producing insulin and other hormones as well as secreting digestive enzymes.

Conditions such as Type 1 diabetes (when the pancreas does not produce insulin at all) or pancreatitis (inflammation of the pancreas) can cause the pancreas to fail. This can cause serious illness.

What are the treatment options for Pancreatic Failure?

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There are three different types of pancreas transplant:

Simultaneous Pancreas Kidney (SPK) Transplant

This is the most common surgery whereby the diabetic patient who also has kidney failure will receive both a kidney and a pancreas transplant simultaneously from a deceased donor to minimise tissue incompatibility. The transplanted pancreas will take over the function of the failed pancreas and produce the hormones and enzymes essential for health. This greatly reduces the possibility of diabetes-related complications in the future and the patient will no longer need insulin therapy. The transplanted kidney removes fluid and waste from the body and dialysis will no longer be needed.

Pancreas Transplant Alone (PTA)

The surgery involves placing only a healthy pancreas into the patient. This is usually performed for patients with Type 1 diabetes and without kidney failure, whose blood sugar levels are difficult to control despite correct insulin injections, or have frequent hypoglycaemic attacks and hypoglycaemia unawareness.

Pancreas After Kidney (PAK) Transplant

This surgery is usually performed when:

Patients with Type 1 Diabetes who have undergone a successful kidney transplant for treatment of kidney failure previously, but have difficulty controlling their blood sugar levels despite the doctor’s advice. Patients may be then recommended to undergo a pancreas transplant.
To avoid the need for dialysis, or a long waiting time on dialysis which may lead to additional health complications, patients may be recommended to go for a living donor kidney transplant first. The pancreas transplant will subsequently be performed upon availability of a pancreas from a deceased donor, after the patients have recovered from the kidney transplant surgery.

Simultaneous Pancreas Kidney (SPK) Transplant

SPK transplant is the most common surgery for patients with kidney failure and insulin-dependent diabetes.

SPK transplant may be considered if:

Type 1 diabetes cannot be well-controlled with standard treatment
There are frequent insulin reactions (diabetic shock)
Blood sugar control is poor
There is severe kidney damage
You have hypoglycemic unawareness or frequent hypoglycemic attacks
A Type 2 diabetic has both low insulin resistance and low insulin production

Patients with Type 2 diabetes are less commonly offered SPK transplant as the cause of their diabetes is due to the body’s inability to use insulin and not because of the pancreas’ inability to produce insulin. However, some of them who are on insulin may be suitable to receive SPK transplants.

For diabetic patients who have received a SPK transplant successfully, they will have normal insulin production and improved blood sugar control, preventing many diabetes-related complications. They will no longer need any insulin injections, and will be free from the dietary and activity restrictions which were caused by diabetes, thus improving their quality of life.

However, serious side effects may be caused by the anti-rejection medications taken after the transplant. Therefore, a transplant recipient has to be fit to undergo major surgery and the benefits of getting a SPK transplant must be outweigh the risks involved.

Your doctor will discuss the possibility of a SPK transplant with you if you are suitable.

FAQs for Getting a Pancreas Transplant

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Who is eligible for a pancreas transplant?

Who can I get a donor pancreas from?
What do I need to prepare for my first visit?
What are the criteria for me to be added to the national waiting list?
How long is the wait time ?
How does the evaluation process work?
What do I need to prepare before the surgery?
What are the risks involved during surgery?
What happens during the surgery?

1. Who is eligible for a pancreas transplant?

The transplant team will assess your suitability for a pancreas transplant based on:

Your medical history. Not everyone is suitable for a pancreas transplant. You will need to be below 55 years old and do not have heart disease, Hepatitis B, Hepatitis C, or HIV infection, or cancer. You must not be severely overweight.
Your health. Your body needs to be healthy enough to undergo surgery and tolerate post-transplant medications.
Your discipline: Recommendations from the transplant team must be followed strictly and you will need to take the medications for life.

2. Who can I get a donor pancreas from?

A donor pancreas comes from a deceased donor.

3. What do I need to prepare for my first visit?

You will need to bring:

Your medical records, test results and medical reports from your current healthcare provider.
Your list of medications, including traditional/herbal supplements.

Think about any question(s) concerning organ transplantation that you would like the doctors to address. If your family member(s) are involved in your decision making and would to find out more, you may ask them to join you for the first consultation.

4. What are the criteria for me to be added to the national waiting list?

You must be:

A Singaporean or Permanent Resident
Deemed medically suitable
Less than 70 years old

Once you have decided to go ahead with a transplant, you will be placed on the national waiting list, where you wait for a suitable organ from a deceased donor to be available.

5. How long is the wait time?

The wait time depends on your blood group as the deceased donor’s blood and tissue types must be a match.

6. How does the evaluation process work?

You will need to undergo several tests and screenings such as:

Blood type: Your blood type should be compatible, even if it is not the same as the donor.

Recipient blood group	Compatible donor blood group	Incompatible donor blood group
O	O	A, B, AB
A	A, O	B, AB
B	B, O	A, AB
AB	A, B, AB, O	NIL

Tissue type test: This is a blood test for genetic makeup. The more genetic markers you share with the donor, the better the match.
Mental health assessment: You will need to undergo a counselling session and be assessed for any psychological issues.
Diabetes-related tests: To confirm the type of diabetes you have.

Step 2
You will be reviewed by the transplant doctor after the initial tests are done. If you are deemed potentially suitable for a pancreas transplant, you will then need to undergo a chest x-ray, electrocardiography (ECG) and more detailed heart scans, as well as other investigations as necessitated by your medical conditions. This will take at least two weeks.

Step 3

Appointments will be made for you to see various specialty doctors as required by your medical condition(s). For example, if you have a heart problem, you will need to see a cardiologist. You will also undergo the final step of tests as needed.

You will be seen by:

A surgeon who will inform you the risks of the operation and discuss the details of the operation.
A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for a pancreas transplant.
Other specialists as recommended by the transplant doctors.

Once the transplant team has assessed that you are suitable for a pancreas transplant, you will have a final review with the transplant doctor and be placed on the national waiting list.

7. What do I need to prepare before the surgery?

To ensure that you are fit for transplant, the pancreas transplant coordinator will contact you regularly to arrange for tests or evaluations. You will need to take good care of yourself, especially while on dialysis.

Some ways to increase your chances of a successful transplant include:

Taking your prescribed medications on time
Turning up for all your medical appointments
Keeping to a healthy diet and exercising regularly to maintain a healthy weight
Not smoking

It is important to remain contactable as the pancreas and kidney from a deceased donor may be available any time. You must come down to NUH for the transplant immediately as the surgery must happen within a few hours after the organs are removed from the deceased donor.

You may wish to prepare a bag with necessities on standby for your hospitalisation needs.

8. What are the risks involved during surgery?

Some complications of a SPK transplant include:

Blood clots
Bleeding
Infection
Hyperglycemia or other metabolic problems
Urinary leaks/complications
Bowel leaks/complications
Failure or rejection of the donated pancreas and/or kidney

9. What happens during the surgery?

Pancreas and kidney transplantation surgery involves placing the donor’s healthy pancreas and kidney into your abdomen. After the operation, the transplanted organs take over the functions of your failed pancreas and kidney.

The donor’s pancreas will be positioned on the lower right side of your abdomen. For SPK or PAK transplant, the donor’s kidney will be positioned on the lower left side of your abdomen. Both organs are surgically attached to the blood vessels nearby. The donor ureter (tube carrying urine from the transplant kidney to the bladder) will be attached to your bladder if the kidney transplant is done. The pancreas is attached to the small bowel for the drainage of digestive enzymes. The SPK surgery takes approximately eight to ten hours, whereas that for PA and PAK is generally shorter at six to eight hours.

Your own kidneys and pancreas will not be removed during the transplantation surgery.

FAQs for Post-Pancreas Transplant

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How long will it take for me to recover after the surgery?

What happens after discharge?
What do I need to take note of after the surgery?
What are the side effects of the anti-rejection medication?
What are the signs and symptoms of pancreas and/or kidney rejection?
What if my body rejects my new pancreas and/or kidney?

1. How long will it take for me to recover after the surgery?

After the surgery, you will be in the High Dependency Unit for a few days so that you can be monitored closely. The transplanted pancreas may not work immediately after the operation, therefore insulin injections will be continued for a period of time.

Once your condition stabilises, you will be transferred to a normal ward to recuperate for about a week. There will be soreness or pain around the surgery site.

2. What happens after discharge?

Your transplant team will develop a checkup schedule for you as close monitoring is needed for the next one month. It is important that you keep to your regularly scheduled appointments.

You will need the take the anti-rejection medications for life to help prevent your body from rejecting the new organs. Without proper levels of these immunosuppressants, the pancreas and kidney will be rejected and you will once again need to inject insulin to control your blood sugars, or to start dialysis for treatment of the kidney failure. During the checkups, the transplant team will assess if your newly transplanted organs are functioning well, and adjust your immunosuppressive medicines as needed.

3. What do I need to take note of after the surgery?

Mental Health

It is normal to have a mix of emotions as a transplant is a major life change. There could be several reasons, such as mood changes due to the immunosuppressants or feeling stressed about your new lifestyle. You are not alone.

Let your transplant team know how you are feeling so that they can help to support you and adjust your medicine if needed. They may also refer you to a psychologist.

Diet and nutrition

Maintaining a healthy diet and exercising regularly can help to prevent some common post-transplant complications such as heart attacks. It will also help to keep your pancreas and kidney healthy.

Your transplant team will refer you to a dietitian who will work around your nutrition and dietary needs and recommend you foods for your nutrition plan. You can also ask your dietitian any questions you may have.

Exercise

You can explore walking, jogging, cycling, swimming and other low-impact physical activities. Check in with your transplant team if you want to start or change your post-transplant exercise routine.

Travelling

It is important to have recovered fully before you travel overseas. Your transplant team may recommend that you wait between two and twelve months after your surgery before you travel. You will need to have enough immunosuppressants for your overseas trip. Let your transplant team know your travel plans as you may need to take vaccines or avoid certain foods depending on your destination.

Driving

It is recommended to wait for at least two weeks after your transplant before you start driving. Some of the medications you need to take right after the surgery may cause tremors and vision changes. It will be safer to have company in your ride when you start driving again.

Sex Life and Pregnancy Plans

Avoid having sex for four to six weeks after your transplant until your surgery site has healed to prevent the wound from opening again.

For females, your menstrual period may become more regular after the transplant. This means that you will more likely to become pregnant. It is recommended to wait one year after your transplant before getting pregnant. Check in with your doctor to find out which birth control method will be more suitable for you.

4. What are the side effects of the anti-rejection medication?

The side effects may include:

Osteoporosis
High cholesterol
High blood pressure
Nausea
Diarrhoea
Sensitivity to sunlight
Weight gain
Swollen gums
Acne
Excessive hair growth or hair loss
Cataracts

5. What are the signs and symptoms of pancreas rejection?

Signs and symptoms that your body may be rejecting your new pancreas include:

Fever of more than 38^oC
Excessive tenderness at the surgery site
Vomiting episodes
Decreased urination
Increased blood sugar levels
Pain at the stomach area

Inform your transplant team immediately if you experience any of these symptoms.

6. What if my body rejects my new pancreas ?

It is not unusual if your body rejects the new pancreas within the first few months of your transplant. Your transplant team will put you under intensive anti-rejection medications for treatment.

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Find A Doctor

Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.

You can search by –

• Condition name ‘Pancreas Transplant’ AND

• Institution

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2022/04/01