What to Know About a Combined Kidney and Pancreas Transplant

A combined kidney and pancreas transplant is the most common procedure for replacing your pancreas.

It’s frequently used for people with type 1 diabetes who also have chronic kidney disease. Some people receive kidney-pancreas transplants to treat people with type 2 diabetes, but this is relatively rare.

For most combined transplants, the organs come from a deceased donor.

While a live donor who is a close match (such as a sibling) could donate a kidney, a live donor cannot donate a whole pancreas. It’s possible for a live donor to donate a pancreas segment, but this isn’t something normally done during a kidney-pancreas transplant procedure.

A 2020 review indicates that the five-year survival rate after a combined kidney and pancreas transplant is 90%. Additionally, these transplants have been found to:

• improve the chances of achieving insulin independence
• slow the progression of vascular diseases
• improve symptoms of neuropathy and retinopathy

Combined liver and kidney transplants are most often used to treat people with type 1 diabetes who also have kidney failure. There are other treatment options for people who don’t have both of these conditions.

If you are a good candidate for a combined liver and kidney transplant, you’ll undergo an evaluation at a transplant center. Different transplant centers might use different criteria before adding you to a transplant waitlist.

Some of the things that transplant centers will consider during your evaluation include:

• whether you’re healthy enough to tolerate surgery
• whether you will follow through on treatments (before, during, and after surgery)
• if you currently have any serious infections, diseases, or cancer
• if you have obesity
• if you smoke
• if you have a substance abuse disorder

A combined kidney and pancreas transplant is a major surgery performed at a transplant center. You will receive general anesthesia before the procedure begins, and you will remain asleep during the entire procedure.

Unlike some other major surgeries, you may not have much notice before your transplant because organs from a deceased donor can only be used for a limited period of time.

In most transplant centers, surgeons will make an incision in your lower abdomen. Your own pancreas and kidney(s) do not necessarily need to be removed. Donor organs can be transplanted to other locations that might be easier or safer to operate on.

For example, the donor pancreas is usually transplanted to the area near your right ilium — the large bone on the side of your pelvis — and the kidney is transplanted near your left ilium. See the illustration below for how donor organs might be placed in a combined kidney and pancreas transplant.

Within a few hours of your transplant, your new pancreas will start producing insulin. Most people will no longer require insulin injections at this point.

You can expect to spend at least the next week in the hospital as you recover. Sometimes, you may need to stay as long as a month. During this time, doctors will monitor you for infections after the surgery, and they’ll make sure your transplanted organs are functioning as expected.

You’ll also need to start taking anti-rejection medications. If your body’s immune system doesn’t recognize the transplanted organs, it may reject them. These drugs suppress your immune system to try and avoid rejection. You will remain on anti-rejection drugs permanently.

One major risk of a combined transplant is that your body could reject one or both of the transplanted organs.

In order to avoid this, you will need to take anti-rejection drugs. Because anti-rejection drugs suppress your immune system, you will also be at a greater risk for infections. Signs of infection include:

• fever over 100°F ( 37.7°C)
• drainage from your surgical scar
• burning during urination
• a cold or cough that won’t go away

Be sure to call your doctor or transplant center if you experience any of the above signs of infection.

Other possible risks after a transplant surgery include:

• blood clots (thrombosis)
• pancreatitis
• fistulas
• hemorrhage

Combined kidney and pancreas transplants have been shown to improve quality of life and increase life expectancy.

The five-year survival rate after a combined kidney-pancreas transplant is 90%. This research also suggests that the 10- and 20-year survival rates are better after a combined transplant than after a kidney transplant alone. The most important factor was that the transplanted pancreas was still functioning one year after transplantation.

Another study found that short-term outcomes aren’t affected by age. However, long-term functioning of the transplanted organs was more likely for people between the ages of 30 and 50 than for younger or older adults.

Is it possible to have a kidney and pancreas transplant at different times (rather than simultaneously)?

Yes. In some cases, your doctor may recommend a pancreas after kidney (PAK) transplant, where you receive a kidney transplant first and then a pancreas transplant later.

Having a pancreas transplant first (before kidney) is not a common procedure.

How long is the wait for a kidney and pancreas transplant?

Approximately 1,200 to 1,500 people are on the waitlist for a combined kidney-pancreas transplant at any given time.

The Organ Procurement and Transplant Network (OPTN) established a kidney-pancreas allocation system in 2014 and then updated it in 2019 to help better serve people waiting for a transplant.

How much does a kidney and pancreas transplant cost, and is it covered by insurance?

If you have private insurance, combined kidney and pancreas transplants may be fully or partially covered if you meet certain criteria (including medical necessity). This can vary between providers and plans.

If you have Medicare, some of the costs of a combined transplant are typically covered.

Your transplant center and insurer can both help you determine the total cost of a combined transplant, including post-operative treatments.

How many kidney and pancreas transplants are done each year in the United States?

In recent years, between 800 and 900 combined kidney-pancreas transplants have been performed annually in the United States.

If you have a combined kidney and pancreas transplant, you’ll receive both organs from a donor. This type of transplant is most often used to treat people who have both diabetes and kidney failure.

You will need to work with a transplant center to be added to the transplant waiting list before you can have this procedure.

A kidney-pancreas transplant is a major surgical operation. You should expect to recover in the hospital for a week to a month. You’ll also need to remain on anti-rejection medications for the rest of your life.

The outlook after having a combined kidney-pancreas transplant is good, and there are quality of life benefits as well. After the transplant, you may be able to stop undergoing dialysis and stop taking insulin.