Diabetes mellitus is the leading cause of end-stage renal disease (ESRD), accounting for approximately 40 percent of newly diagnosed patients with renal failure every year. Whether you are in the beginning stages of diabetic complications or deteriorating kidney function, we understand that you and your family will have questions. That is why we have a designated transplant team member who is available to talk with you about your disease, various treatment options and which options are best suited for you. In addition, our team of doctors, nurses, technicians, dietitians, social workers and many others is available to provide care and support throughout the transplant process, during your hospital stay and even after you return home.
Kidney/Pancreas or Pancreas Only Pre-Transplant Evaluations
To be considered as a candidate for kidney/pancreas or pancreas only transplantation, you will first undergo a thorough transplant evaluation. The evaluation will help our transplant team learn more about you and your disease. This also will give you the opportunity to learn more about our kidney/pancreas transplant team and program.
During this process, the transplant physicians will be looking for medical and/or emotional conditions that would affect the chances for a successful transplant.
- Blood tests
- Heart tests
- Dental exam
- Complete physical exam
You will meet with a transplant coordinator, transplant surgeon, transplant nephrologist, psychologist, social worker, transplant financial counselor, transplant pharmacy counselor and dietician during the transplant evaluation. These visits or appointments will help the transplant team determine if there are special concerns that you or your family may have regarding the transplant and what type of support is needed for a successful transplant outcome.
This will include samples for ABO, Human Leukocyte Antigen (HLA) Tissue Typing and Cytotoxic Antibodies.ABO
This test shows your blood type (A, B, AB, O). Your blood type needs to match or be compatible with the blood type of the donor.HLA Tissue Typing
HLA reveals a set of antigens. Antigens are inherited from each parent. The HLA typing helps the transplant surgeon to find the best match with a potential donor.Cytotoxic Antibodies
This test will show the level of antibodies that have formed against certain antigens. An antibody occurs from being exposed to other tissues or blood. This exposure can come from events such as blood transfusions, delivery of a baby or previous transplants.
If the antibody level is high, it may be more difficult to find a compatible match with a donor, which could extend your time waiting for a transplant. The transplant coordinator will arrange for you to have a sample of blood drawn once a month and sent to the Transplant Center. This is done to monitor the levels of antibodies in your blood and to cross match your blood when a potential donor becomes available. All of these steps improve your chances of having a successful transplant and reduce the risk of possible complications that could arise after surgery.Waiting for Transplantation
The amount of time you wait for a transplant varies depending upon the blood type, antibody level, medical condition, number of other patients on the waiting list and the availability of donor organs. Some patients have waited only one day; others have waited months to years.
A kidney/pancreas or pancreas-only transplant is performed through a midline incision in the center of the abdomen. The pancreas is generally placed on the right side of the abdomen; the kidney, if performed at the same time, is placed on the left side of the abdomen. The kidney and pancreas are attached to the necessary blood supply. The kidney is attached to the bladder for urine drainage. The pancreas is connected to the bladder or the bowel to drain the pancreatic enzymes into the bladder or bowel. Generally, the native kidneys are left in place; however, exceptions to this may be made in the event of infection, the potential for infection or the presence of cancer. The native pancreas is left in place.
After the Operation
After the operation, you will be in either a private room in the Solid Organ Transplant Unit or in the Intensive Care Unit for recovery. The new kidney should start to work soon after the surgery, but it may be necessary to have dialysis in our inpatient dialysis facility until the kidney begins to work. The pancreas should also start to work soon after surgery, but it may be necessary to continue the use of insulin such as an insulin (intravenous) drip until blood sugars are in an acceptable range.
After your surgery, the transplant coordinator and doctors will instruct you on the following:
- How to take your medications
- Warning signs to look for
- How to read the blood tests and determine early signs of any problems
- When to call the Transplant Office
Immunosuppressive (Anti-rejection) Medications
Both before and after the transplant surgery, you are given immunosuppressive (anti-rejection) medications. These are strong medications to help prevent rejection. These medications must be taken as long as you have the transplanted kidney. To determine a safe level of these drugs, your blood will be tested and the medication levels will be watched very closely by the transplant team. It is very common for the transplant team to make frequent changes in medication doses after transplant to keep the anti-rejection medications in a safe range and yet prevent rejection.
Some problems occur as a result of the side effects of the needed medications. The most common side effect is the lowering of the ability to fight infection. The transplant surgeon and coordinator will discuss other potential problems that include signs and symptoms of rejection and infection.
All treatments for kidney disease and diabetes have potential complications and transplantation is no different. As a transplant patient, you need to be aware of the possibility of rejection and infection.
Rejection occurs when the body fights the donor's kidney and/or pancreas. This happens because the new kidney and/or pancreas are foreign tissue. Rejection is the most common reason for transplant failure. There are three types of rejection:
- Hyper-Acute Rejection - This type is very rare, but it can occur minutes or hours after surgery and is not treatable. If it occurs, the kidney and/or pancreas must be removed and dialysis and/or insulin must be resumed until another kidney and/or pancreas is available.
- Acute Rejection - This can occur anytime, but it is most common in the first year after transplant. This type of rejection is usually reversible with anti-rejection medications.
- Chronic Rejection - This occurs slowly and over a long period of time. There is usually no treatment. The kidney and/or pancreas function may decrease to the point that dialysis and/or insulin is required. If this occurs, you may decide to try another transplant. Some patients have had two or more transplants.
The medications to protect you from rejection lower your immune system and put you at increased risk for infection. The risk of infection is the greatest right after transplant or after treatment for rejection. Some of the infection complications you may experience right after transplant may be a reactivation of viral infections that you may have had as a child. More specific information will be provided to you during the transplant evaluation and post-transplant education.
The extraordinary care that you received while hospitalized at Nebraska Medicine does not end at the time of discharge. The kidney/pancreas team continues to follow and monitor your progress. To answer any questions after your transplant, our team is available to you, your family members and your local physician.
You play a very important part in making your transplant a success. There are four basic patient responsibilities after transplant:
- Take all medications as instructed
- Have lab work done as scheduled
- Call the transplant coordinator or doctor if there are any symptoms of rejection, infection or any other problem
- Keep regular appointments with your doctor