Multi-Organ Transplant Program

Adult Kidney-Pancreas Transplant

Diabetes is the leading cause of end-stage kidney failure in North America. When blood glucose levels are constantly elevated, the kidneys' filtration mechanism becomes stressed. Their very small blood vessels become damaged, and the kidneys begin to leak. Without medical help, end-stage renal failure is life threatening.

Treatment for Diabetic End-Stage Kidney Failure

Dialysis and insulin injections are treatments for diabetic patients with end-stage diabetic disease. They do not, however, stop all the complications from diabetes, and kidney failure can still occur and even progress. Kidney transplantation alone is a treatment choice for diabetic patients with end-stage diabetic kidney disease. Despite the survival benefits of renal transplantation, the majority of diabetic patients suffer through progression of diabetic eye, vascular, and nerve disease and continued deterioration of kidney function. Over the years, kidney-pancreas transplantation has been recognized as a surgical option for young Type I diabetic patients with end-stage renal failure. Successful control of diabetes can be achieved with pancreatic transplantation in patients with Type I diabetes (juvenile diabetes). For this reason, a kidney-pancreas transplantation offers a greater advantage over other treatment options.

One of the most compelling indications for pancreatic transplantation is hypoglycemic unawareness. Patients with hypoglycemic unawareness are not aware of hypoglycemic (low blood sugar) episodes and may lapse into a coma without warning. These patients are at high risk for sudden death. Through pancreas transplantation, these patients avoid fluctuations of blood sugar levels and the need for ongoing insulin therapy. The other major benefit of pancreatic transplantation is stabilization of diabetic complications.

You can find out more about the transplant assessment process at LHSC for kidney and kidney-pancreas transplantation.

The Kidney-Pancreas Transplant Operation

There are three options for pancreas transplantation: the pancreas can be transplanted simultaneously with a kidney from the same donor; transplanted after a living or deceased donor kidney transplant; or transplanted alone. With simultaneous kidney-pancreas transplantation, the recipient undergoes one operation that uses both organs from the same donor. With pancreas after kidney transplantation, the recipient undergoes two separate operations from two different organ donors. Pancreas-alone transplants are performed to prevent the development of diabetic complications.

In 2004, LHSC began a kidney-pancreas transplant program, with a projected volume of 8 to 10 transplants annually. Currently, our program only performs simultaneous kidney-pancreas transplants.

Kidney-pancreas transplant surgery takes between four and six hours. During this operation, the donor kidney is inserted and attached through an incision in either the right or left lower abdomen. The surgeon attaches the artery and vein of the new donor kidney to the iliac artery and vein, then attaches the ureter to the bladder. The recipient's own kidneys remain in place. The donor pancreas is placed in the abdomen and attached to either the bowel or bladder. Generally, the recipient’s own pancreas remains in place and is not removed because it continues to supply digestive enzymes and perform exocrine functions.

In the recovery room, the pulse, blood pressureand respiratory rate are monitored. Urine output is measured because that gives the staff an indication of how well the new kidney is functioning. They also monitor the blood sugar level, which indicates the immediate production of insulin by the transplanted pancreas. Most of the patients are transferred to the Multi-Organ Transplant Unit one or two hours after surgery.

Quality of Life

Successful kidney-pancreas transplants dramatically improve the quality of patients' lives. A new pancreas provides regulated insulin production and cures the diabetes, and the new kidney eliminates the need for dialysis. Simultaneous kidney-pancreas transplantation has a one-year survival rate of 84% for the pancreas graft and 91% for the kidney graft. At three years, 80% of pancreas grafts are still functioning. Overall, a combined kidney and pancreas transplant will last an average of 12 to 15 years.

Contact Information

Recipient Coordinators: Jessica Blaskie, 519.685.8500 ext 33851 and Diane Smith, 519.685.8500 ext 32331