As donor pancreases are scarce, you'll need to be assessed carefully to determine whether a pancreas transplant is suitable for you and you could benefit from one.

When pancreas transplants are considered

A pancreas transplant is usually only considered in a small number of people with type 1 diabetes. 

There are around a million people in the UK with type 1 diabetes, but only about 200 get a pancreas transplant each year.

Type 1 diabetes happens when the immune system destroys the cells (islets) in the pancreas that produce a hormone called insulin.

It can often be controlled with insulin injections, so the risks of a pancreas transplant outweigh the benefits in many cases.

But a transplant may be considered if:

• you also have severe kidney disease, whether it's caused by diabetes or not – a pancreas transplant may be carried out alongside a kidney transplant in these cases
• you have severe episodes of a dangerously low blood sugar level that happen without warning, in spite of good insulin control

If a healthy pancreas is transplanted into your body, it should start producing insulin immediately, relieving diabetes symptoms and replacing treatment with insulin injections.

Assessment for a pancreas transplant

You'll have a detailed assessment at a transplant centre to find out more about your health and check whether there are any underlying problems that could affect your suitability for a pancreas transplant.

This will usually involve having several tests, such as:

• checks of your blood pressure and heart rate
• measurements of your height and weight
• urine and blood tests
• a chest X-ray
• a type of ultrasound scan used to examine your blood vessels (a Duplex scan)
• an ultrasound scan of the heart (an echocardiogram)
• tests to measure the electrical activity of your heart (an electrocardiogram, or ECG)
• a type of X-ray used to study the inside of your heart (cardiac catheterisation and coronary angiography) 

You'll also have the opportunity during your assessment to meet the transplant team and find out more about the operation.

You may find it useful to write down a list of questions you'd like to ask the transplant team before your visit.

Who might not be suitable for a pancreas transplant?

Unfortunately, not everyone who thinks they'd benefit from a pancreas transplant will be suitable for one.

This is because the operation places a major strain on the body and may mean the risks outweigh the potential benefits.

For example, you may be considered unsuitable for a pancreas transplant if you:

• have severe heart disease
• have recently had a heart attack
• have incurable cancer
• have a serious mental health or behavioural condition that means you'd be unlikely to be able to correctly take the medication needed after a pancreas transplant
• are generally in poor health and are unlikely to withstand the strain of surgery and the treatment that follows it
• are very overweight
• drink heavily or abuse drugs

Age is not a factor in determining whether a pancreas transplant is suitable, although the procedure is rarely performed in older people because they often have other health problems that mean a transplant is too risky.

Who decides if you can have a pancreas transplant?

The final decision about whether you're suitable for a pancreas transplant is made by the transplant team.

You may be informed about the decision before leaving the transplant centre.

But if your case is not straightforward, it may be several weeks before you're told the decision.

The transplant team may decide you're:

• suitable for a transplant and ready to be placed on a waiting list – read more about being on the pancreas transplant waiting list
• suitable for a transplant, but your condition does not require a transplant – you'll usually be monitored in case your condition gets worse
• unsuitable for a transplant – the reasons will be explained in detail by your transplant team

In some cases, further tests are necessary to make a final decision, or you may be referred to a different transplant centre for a second opinion.

Once you're assessed as being suitable for a pancreas transplant, you have to join the national waiting list. It's not possible to have one straight away because of the lack of available pancreases.

It may be several months, or possibly years, before a suitable donor pancreas becomes available.

In the UK, half of the people waiting for a pancreas transplant will have had one by around 13 months.

You'll usually be able to stay at home until a pancreas becomes available.

The transplant centre can offer support, guidance and information while you wait for a suitable donor to be found.

Waiting for a suitable donor

While waiting for a donated pancreas to become available, it's important to stay as healthy as possible by:

• taking medicine that's prescribed for you
• keeping all your appointments with your healthcare team
• having a healthy diet
• taking regular exercise, if possible
• not smoking
• not drinking too much alcohol

The transplant centre will need to be able to contact you at short notice, so inform staff if your contact details change.

You should also let staff know if your health changes (for example, if you develop an infection).

Prepare an overnight bag and make arrangements with your friends, family and employer so you can go to the transplant centre as soon as a donor pancreas becomes available.

Coping with being on the waiting list

Living with severe diabetes can be strenuous enough. The added anxiety of waiting for a pancreas to become available can make the situation even more difficult.

This can have an effect on both your physical and mental health.

Contact a GP or the transplant centre for advice if you're struggling to cope emotionally with the demands of waiting for a transplant.

You may also find it useful to contact a support group, such as Diabetes UK or Diabetes.co.uk, or a local kidney patients association if you're also waiting for a kidney transplant.

Getting the call

When a suitable donor pancreas is found, the transplant centre will contact you and ask you to go to the centre.  

When you hear from the transplant centre:

• do not eat or drink anything (unless your blood sugar is very low)
• take all current medicines with you
• take a bag of clothes and essentials for your hospital stay

At the transplant centre, you'll be reassessed quickly to make sure no new medical conditions have developed.

When the medical team has confirmed that you and the donor pancreas are suitable, you'll be given a general anaesthetic.

The procedure must be carried out as quickly as possible to have the best chance of success.

Find out more about what happens during a pancreas transplant

Transplant centres

Pancreas transplants are carried out at specialist transplant centres.

UK transplant centres that perform pancreas transplants are located in:

• Churchill Hospital in Oxford
• Freeman Hospital in Newcastle
• Guy's Hospital in London
• Manchester Royal Infirmary
• West London Renal and Transplant Centre at the Hammersmith Hospital, London

Pancreas transplants are carried out under general anaesthetic. This means you'll be asleep and will not feel anything during the procedure.

• A cut will be made in your tummy, from just below your breastbone to below your belly button.
• The donor pancreas is usually placed in the right side of your tummy and is connected to the blood vessels that carry blood down to your leg.
• A small portion of the donor's small intestine will be attached either to your small intestine or your bladder to allow digestive juices to drain from the donor pancreas.
• If you're having a combined pancreas and kidney transplant, the kidney will be placed low down on the left side of your tummy.
• The old pancreas will not be removed as it'll continue to produce digestive juices while the donor pancreas produces insulin.

A pancreas transplant operation can take 4 to 5 hours to complete.

If you also need a kidney transplant at the same time, the operation can take around 6 to 8 hours.

Your new pancreas should start to produce insulin straight away.

Islet transplantation

A small number of people with type 1 diabetes may have a slightly different procedure, where only the cells that produce insulin (islet cells) are transplanted from a donor pancreas into the liver.

This is called islet transplantation and is usually carried out under local anaesthetic, which means you're awake but the area being operated on is numbed.

A thin, flexible tube (catheter) is inserted through your tummy and liver into the vein that supplies the liver with blood. The donor islet cells are then injected into it.

If the operation is successful, the donor cells will start making insulin. This can help people who experience severe episodes of a dangerously low blood sugar level that occur without warning.

Insulin treatment is often still needed after the operation, but the episodes of low blood sugar should be easier to control.

As with a conventional pancreas transplant, you'll need to take medicine to suppress your immune system for the rest of your life.

For more information, see the National Institute for Health and Care Excellence (NICE) guidance on allogeneic pancreatic islet cell transplantation for type 1 diabetes mellitus.

After the operation

Once the transplant is complete, you'll usually be moved to an intensive care unit (ICU) or a high dependency unit (HDU).

You'll be very closely looked after, and various tubes and machines that help monitor your health and support the functions of your body will be attached to you.

Find out more about recovering from a pancreas transplant

You'll usually need to stay in hospital for 2 to 3 weeks after a pancreas transplant.

Recovering in hospital

When you wake up after having a pancreas transplant, you'll first be cared for in an intensive care unit (ICU) or a high dependency unit (HDU).

You'll usually be moved to a general transplant ward after 12 to 24 hours.

While in hospital, you'll be attached to various tubes, monitors and machines.

These may include:

• a machine that delivers painkillers through a tube into your body, controlled using a handheld device
• an oxygen mask
• tubes that provide nutrients and fluid into a vein, or a feeding tube that goes through your nose into your stomach
• tubes called drains that remove blood and other fluid from the operation site
• a tube in your bladder that allows you to urinate without going to the toilet (urinary catheter)

If you have also had a kidney transplant, you may need temporary dialysis, a treatment that replicates some of the kidney's functions.

Follow-up appointments

You'll have regular follow-up appointments to monitor your progress after a pancreas transplant.

These will be quite frequent at first, but may eventually only be necessary once every few months.

During these appointments, you'll have tests to check how well your pancreas and medicines are working, and also check for any complications of a pancreas transplant.

Immunosuppressants

You'll need to take several medicines called immunosuppressants for the rest of your life after having a pancreas transplant.

Without these medicines, your body may recognise your new pancreas as foreign and attack it. This is known as rejection.

Immunosuppressants are powerful mediciness that can have a range of significant side effects, such as an increased chance of getting certain infections.

While the side effects may be troublesome, you should never stop taking your immunosuppressants without medical advice. If you do, it could lead to your pancreas being rejected.

Find out more about immunosuppressant side effects

Getting back to normal

You should be able to return to most of your normal activities after a pancreas transplant, although this can take a while.

• You may need a few months off work.
• Your stitches will need to be taken out at around 3 weeks.
• You will not usually need to take insulin, restrict your diet and measure your blood sugar regularly any more.
• You can normally start gentle exercise from 6 weeks, as long as you feel fit enough.
• Light lifting is often possible after 6 weeks, but you should not lift anything heavy, such as a shopping bag, for a few months.
• More vigorous activities, such as contact sports, may not be recommended, at least in the short term, as they could damage your new pancreas.

Your healthcare team will tell you about any activities you should avoid during your recovery, and can advise you about when it's safe to start them again.

A pancreas transplant is a major operation. As with all types of surgery, there's a risk of complications.

Some complications can happen soon after the operation, while others may develop months, or even years, later.

Some of the main risks associated with a pancreas transplant are described below.

Rejection

One of the most common complications of a pancreas transplant is rejection of the donor pancreas.

This is where the immune system recognises the transplanted pancreas as foreign and attacks it.

Rejection usually occurs in the days, weeks or months after the transplant, although it can sometimes happen years later.

Immunosuppressant medication can reduce the risk of this happening.

Symptoms of rejection include:

• pain and swelling in your tummy
• a high temperature
• being sick
• chills and aches
• extreme tiredness
• puffy, swollen ankles
• shortness of breath

Contact a GP or your transplant team as soon as possible if you have these symptoms.

Rejection can usually be treated by increasing your dose of immunosuppressant medicine.

Immunosuppressant side effects

The immunosuppressant medicines you need to take to prevent rejection can have a number of significant side effects.

These can include:

• an increased risk of getting infections
• shaky hands
• difficulty sleeping
• high blood pressure
• hair loss or thinning
• mood swings
• weight gain
• an upset stomach
• a rash
• weakened bones (osteoporosis)
• an increased risk of certain types of cancer, particularly skin cancer

Speak to your transplant team if you have any troublesome side effects.

Do not stop taking your medicine without getting medical advice first.

Infections

Immunosuppressant medicine will weaken your immune system and make you more likely to get an infection.

While taking the medicine, it's a good idea to:

• report any possible symptoms of an infection to a GP or your transplant team immediately – things to look out for include a high temperature, aching muscles, diarrhoea or headaches
• ensure your vaccinations are up to date – speak to a GP or your transplant team for advice about any additional vaccines you might need as some are not safe if you're taking immunosuppressant medicines
• avoid close contact with anyone who has an infection – even if it's an infection to which you were previously immune, such as chickenpox

To help prevent infection, you may be given antibiotics, antifungal medicine or antiviral medicine to take for the first few weeks or months after your transplant.

Blood clots

Blood clots can sometimes form in the blood vessels that supply the new pancreas, which can stop it working properly.

The risk of this happening is highest in the days after the operation, so you'll be closely monitored in hospital to check for any signs of a blood clot.

You'll also be given blood-thinning medicine to reduce the chances of a clot forming.

If a blood clot does develop in the new pancreas, you'll usually need another operation to remove it.

Blood clots can also form in other blood vessels after surgery, such as those in your legs (deep vein thrombosis) or supplying your lungs (pulmonary embolism), but taking blood-thinning medicine should help prevent this.

Pancreatitis

Pancreatitis is swelling of the pancreas, and is common in the first few days after surgery.

It can happen as a result of storing the donor pancreas on ice in preparation for the transplant.

Symptoms of pancreatitis include:

• a dull pain in your tummy
• feeling sick
• vomiting

Pancreatitis should pass within a few days. But sometimes tubes may need to be placed in your tummy to drain any excess fluid off the donor pancreas, and in a few cases it may be necessary to remove it.