Recovery

Pancreas and Islet Cell Transplantation Recovery

For pancreas transplant patients, the pancreas survival rates at one year are between 80 and 85 percent, and patient survival is over 97 percent.

In the case of simultaneous pancreas/kidney transplantation, patient survival is between 95 and 97 percent at one year. About 90 percent of transplanted kidneys and about 85 percent of the transplanted pancreases still “work” one year after surgery.

We will provide you with the most recent results from Northwestern Memorial Hospital as listed in the Scientific Registry of Transplant Recipients (SRTR). You also can go to the SRTR website to view results from Northwestern Memorial, as well as from all other transplant centers in the United States. This database is updated every six months.

Recovering from pancreas and islet cell transplantation surgery

After pancreas and islet cell transplantation surgery, you will likely be in the Intensive Care Unit for up to 24 hours, as your transplant team* monitors your vital signs and checks for complications. If you had a simultaneous kidney transplant, you may also need dialysis as your new kidneys begin to function. You will remain in the hospital for up to one to two weeks after surgery.

Once you are home, you will participate in a variety of activities as you heal:

• Physical therapy to build body strength
• Nutritional counseling to avoid weight gain associated with anti-rejection medications
• Psycho-social counseling
• Outpatient testing, including:
  • Blood tests
  • Abdominal imaging tests
  • Occasional biopsies to check for rejection

Since 2013, we have recruited type 1 diabetic patients for a new islet cell transplant trial with new immunosuppression regimens. Following the footsteps of our success in achieving transplant tolerance (a state that allows complete withdrawal of immunosuppression) in kidney transplantation, we are currently testing a robust tolerance strategy for islet cell transplantation in pre-clinical models, with the anticipation of launching a clinical trial for tolerance induction in islet cell transplantation in the near future.

About rejection

A major concern after transplant surgery is the risk of organ rejection. Acceptance of transplanted pancreases is generally good, with rejection in just one percent of patients each year.

Rejection happens when your body stops accepting your new organ. When this occurs, your immune system attacks your new pancreas, as if it does not belong in your body. This triggers your body to make white blood cells and antibodies, which reduce the blood flow to the pancreas, can damage the new pancreas or limit how well it works.

Acute (sudden and severe) rejection often happens in the first several months after transplant. But rejection can occur at any time. The donated pancreas always retains its original identity. You will need to take anti-rejection medicines for the rest of your life. Failure to do so always will lead to rejection and organ failure.

Watch for signs of rejection:

• A temperature above 100.50 F
• Pain or tenderness over the transplant site
• Feeling like you have the flu
• Abdominal pain

If you notice any of these signs, you must call the Transplant Clinic right away. This allows treatment to begin quickly to help you have the best outcome. Rejection is confirmed with blood work and a needle biopsy of the kidney or pancreas.

Many times, rejection can be detected only by lab tests. You may not have symptoms at all. That’s why it’s very important that you have routine blood tests as directed by your transplant team. We want to detect rejection before you have any symptoms. This allows needed tests and treatment to begin right away.

Infection

Anti-rejection medicines limit the action of your white blood cells (WBCs). WBCs help your body fight infection. When you take anti-rejection medicines you have an increased risk for infection. It is very important that you try to prevent infection and watch for signs of infection.

Call the transplant nurse coordinator right away (day or night) if you have:

• A temperature above 100.5°F
• Nausea, vomiting or diarrhea (more than four watery or very loose stools) for more than 24 hours
• Redness or tenderness around your incision
• Anything other than red-tinged clear drainage from your incision

Call the transplant nurse coordinator during clinical hours if you have:

• A productive cough that lasts more than two days
• A sore throat or mouth sores
• Pain or burning while urinating
• Cloudy urine or a feeling of urgency to urinate

Follow these important but simple steps to help prevent infection:

• Avoid contact with persons who have a cold or flu or other illness.
• Keep your vaccines up to date. Remember that you cannot have vaccines with live viruses. Ask your transplant physician or nurse coordinator to make sure any vaccine is okay.
• Get a flu shot every year and a pneumovax shot every five years.
• Practice good hand washing, which means:
  • Wash your hands for 30 to 60 seconds using soap and warm water. Scrub all areas, including between the fingers, under the fingernails and around the nail beds.
  • You can also use alcohol-based hand rubs and wash for 20 seconds.
  • Use plain soap and water for visibly dirty hands.
  • Use alcohol-based hand-rubs when your hands are not visibly dirty.
  • Always wash your hands when visibly soiled, after you use the bathroom, and before and after you eat.

Just like everyone else, you will get colds and the flu. Your immune system should be able to fight these common infections and you should recover normally. Also, the risk of infection becomes less as your anti-rejection medicines are decreased over time.