Transplant Options

Pancreas Only Transplant
Pancreas alone transplants are performed on individuals who are experiencing the beginning stages of diabetic complications or “brittle” control; frequent episodes of hypoglycemia (insulin reactions) and have adequate renal function to tolerate anti-rejection medications.

Pancreas Transplant After Kidney Living Donor Kidney Transplant
Many times the waiting time for a transplant is very long (up to two to three years) for the combined kidney/pancreas transplant. If a patient has an acceptable kidney donor we can proceed with living donor kidney. When the patient recovers from this surgery, they are placed on the waiting list for a pancreas (after kidney) transplant.

Pancreas Transplant After Deceased (cadaver) Kidney Donor Transplant
Patients who do not have a living kidney donor possibility and who may be anxious to obtain a kidney transplant have the option of being listed for a kidney or kidney/pancreas, whichever comes first. In the event that they receive a deceased (cadaver) donor kidney transplant, they can be reactivated on the waiting list for pancreas (after kidney) when they have recovered from the kidney transplant.

Kidney/Pancreas Transplant
This dual transplant is considered when an individual with Type I diabetes mellitus has developed kidney failure as a result of diabetes and has completed a transplant evaluation and found to be an acceptable candidate for the combined transplant. The patient is placed on the deceased (cadaveric) donor list and receives a kidney and pancreas from the same donor.

Islet Cell Transplantation
Islet cell transplantation is an experimental procedure in which islet cells are taken from a donor pancreas and injected into the liver of patients with Type I diabetes. The beta cells of the islets then begin to make and release insulin with the goal that the patient will no longer need daily insulin injections. The patients will, however, need long-term immunosuppression. The Nebraska Medical Center and The University of Nebraska Medical Center have approval under a research protocol to perform islet transplants.

Options to Reduce Transplant Waiting Periods

The current kidney allocation policy considers characteristics of both the donor and the
transplant candidate in allocating kidneys equitably. A combination of factors determines who receives which organ including length of time on the waiting list, tissue match between the donor and the recipient, blood type, antibody levels, and whether the recipient is a child.

Every year the transplant waiting list grows but the number of organs has not increased to meet the demand. Transplant programs are constantly looking ways to “expand” the donor pool. At The Nebraska Medical Center, we offer a variety of ways to expand that pool, including living donation, laparoscopic donor nephrectomy, anonymous donor program, paired exchange transplants, as well as expanded criteria donor transplants and the use of antibody reduction techniques which are described below.

Expanded Criteria Donors

Although the kidneys that are most commonly transplanted come from previously healthy donors between the ages of 18 and 60, kidneys from other donors with a wide range of characteristics have been successfully transplanted and are called expanded criteria donors. Donors that fall into this “less traditional” category are defined as:

• Age 60 or older
• Between the ages of 50-59 with at least two of the following conditions:
• History of high blood pressure
• Creatinine level greater than 1.5 (creatinine levels measure how well a kidney is functioning. Normal range is 0.8-1.4)
• Cause of death due to a cardiovascular condition (stroke or aneurysm)

Patients who are most likely to benefit from this option include:

• Patients who are not doing well on dialysis
• Patients who are likely to wait a long time on the waiting list and are at risk of developing serious complications or even death if they continue to wait for a transplant.

By agreeing to accept an expanded criteria donor, you may shorten the waiting period for a transplant. However, there is a greater chance that the donor kidney may not function as well or as long. It is essential that you discuss your individual situation with your transplant team. It is also important to know that agreeing to accept an expanded criteria donor does not mean that you will not be considered for standard donor opportunities. The expanded criteria donor option will be discussed with individuals undergoing transplant evaluation and consent will be obtained for those interested in considering this option.

Antibody Reduction

Antibody reduction provides another option to improve a patient’s ability to be transplanted. Many patients waiting on the list for transplant are considered “sensitized”. Sensitized patients are individuals who have developed antibodies in their blood against foreign tissue. These antibodies develop from previous exposure to foreign tissue such as a previous transplant, pregnancy or blood transfusions. These antibodies interfere at the time of cross match between the donor and recipient’s blood causing a “positive” or incompatible cross match and predict that the transplant has little chance of success. Sensitized patients may wait three or four times longer than unsensitized patients for a compatible cadaver transplant. Antibody reduction removes the antibodies in the recipient’s blood prior to the transplant to enable a successful live donor transplant.