Overview

Once you have recovered from your pancreas transplant and your team is happy that your transplanted pancreas is working, you will be ready to leave hospital (be discharged).

Before you are discharged, the ward pharmacist will talk to you about your medicines, what they are for and how to take them. We also give you information about wound care and pain relief. 

Follow-up appointments

We tell you when you will be seen in the transplant clinic for follow-up appointments. 

A few months after your transplant you will be given an appointment at Guy’s hospital to have a special test to see how well your pancreas is working. This is called a mixed meal tolerance test.

Transplant clinics

To start with, we see you 2 to 3 times a week in a transplant clinic to make sure that the pancreas transplant is working well, and that you are getting better as expected. 

We check the amylase levels in your blood at every clinic visit. 

Your long-term blood sugar control (HbA1c) should be checked every 3 months. 

If these blood tests are abnormal, you may be referred to a specialist clinic at Guy’s hospital for further tests.

Diabetes clinic appointments

You should continue to attend your regular podiatry (foot health), and ophthalmology (eye health) clinics.

Foot and eye problems still need monitoring, even if your pancreas transplant is working well.

Mixed meal tolerance appointment

We will give you an appointment at Guy’s hospital to have a special test to see how well your pancreas is working. This test is called a mixed meal tolerance test and will be a few months after your transplant.

You will be given a drink which is a mixture of protein, fat and carbohydrate and tastes like milkshake.

We will take blood tests to see how much insulin the transplanted pancreas is producing, and how your blood sugars respond to the meal.

If there are any concerns about the function of the pancreas, we will contact you to give more information.

It is important that you attend every clinic appointment that is made for you.

Checking important signs and symptoms

Your blood sugar level

High blood sugars can be a sign that the pancreas transplant is not working well.

You should check your blood sugars once a week, before breakfast (fasting) and then 1 hour after lunch the same day.

If your fasting blood sugar is higher than 6.0 mmol/L, or if your blood sugar after lunch is higher than 10.0 mmol/L please inform a member of your transplant clinic team.

Very rarely, people can have a hypo when they have low blood sugars. If you feel like you’re having a hypo (for example, you feel sweaty, tired, dizzy or hungry), please check your blood sugars.

If your blood sugar is less than 4.0 mmol/L, have a sugary drink or snack.

Call for an ambulance if it’s an emergency. Please also inform a member of your transplant clinic team.

People with high or low blood sugars may be referred to a specialist clinic at Guy’s hospital for further tests. They may need to be admitted to hospital for urgent tests and treatment.

Signs of rejection

Rejection usually happens in the first 6 months after the transplant.

This is when your immune system recognises the transplant as coming from someone else and starts to attack it.

Immunosuppressant medicines reduce the risk of rejection. It’s very important that you take your immunosuppressant medicines if you are prescribed them.

Symptoms and signs of pancreas transplant rejection may include:

• high blood sugars
• abnormal blood test results, for example HbA1c or amylase
• pain in your tummy (abdomen)
• being sick (vomiting)

Signs of infection

Infections are common after any surgery, and immunosuppressant medicines can increase the risk.

We give you medicines to help prevent the risk of infections for at least the first few weeks after your transplant.

Symptoms and signs of infection may include:

• a high temperature (38° C or above)
• feeling hot and shivery
• severe headache or confusion
• severe tummy (abdominal) pain
• diarrhoea and sickness
• shortness of breath or chest pain
• tiredness or generally ‘feeling rough’
• pain when going for a wee

Taking immunosuppressant medicines can increase your risk of getting an infection. There is also an increased risk of cancers, especially skin cancers.

Side effects include:

• shaky hands
• hair loss
• diarrhoea or sickness

Bleeding from the pancreas

If there is any bleeding from the pancreas, you may experience:

• severe tummy or back pain
• collapse (please explain what collapses),
• blood mixed in with your poo
• black poo

If you experience any of these symptoms, please contact a member of your transplant clinic team. If you think it’s an emergency, please call an ambulance.

Looking after yourself after discharge

Keep a healthy weight

It’s important that you stay within a healthy weight range. Your transplant clinic team can advise the best weight range for you.

Gaining weight after having a pancreas transplant can add extra workload to the pancreas and will prevent it from working well.

Please let your transplant clinic team know if you would like to be referred to a weight loss clinic.

Diet

What you can eat depends on your kidney function (if you have had a kidney transplant) as well as your pancreas transplant function.

In general, avoid foods and drinks with a lot of fat, sugars or carbohydrates. This will help you maintain a healthy weight and good pancreas function.

Please ask your transplant clinic team to see a dietician if you need more information.

The NHS website has useful information about the Eatwell Guide.

Smoking

If you were a smoker or vaper, you would have been advised to cut down and give up before your transplant. Now that you’ve had a transplant, it’s even more important to stop smoking completely.

Smoking or vaping constricts the blood vessels leading to the newly transplanted organs and your heart and brain, and also slows wound healing.

Read more about how our stop smoking service can help you to give up. You can call the team on 020 7188 0995 or email [email protected]

Alcohol

We recommend you keep well within the national recommended limits of alcohol (maximum of 14 units per week).

14 units is about the same as 6 pints of average-strength beer or 10 small glasses of lower-strength wine.

Any amount of alcohol can damage the liver, especially if you have an underlying condition.

Returning to normal activities

Take it easy for the first 2 weeks at home. You will probably get tired easily, so have plenty of rest. You do not need to stay in bed.

Before starting exercise, driving, or working, please check with your transplant team first. Avoid heavy lifting (more than 10 kg) until at least 6 weeks after your transplant.

Exercise

After you have been home for a few days you can build your strength and stamina by having a short walk each day. Start with 5 to 10 mins and gradually add to your distance every day. Some days will feel easier than others and this is perfectly normal.

Driving

Most patients can start to drive again at about 6 to 8 weeks after the transplant. Please inform the DVLA that you’ve had a pancreas transplant.

Returning to work

Many patients can start to get back to work 12 weeks after the transplant. You can read more about how to get a Fit Note for your employer.

Psychological and emotional support

It is normal to feel a range of emotions after a pancreas transplant. Some transplant patients may feel elated whist others may find it hard to adjust to changes and feel very down. These emotions usually settle with time.

If you would like to speak with a counsellor or psychologist, please inform a member of your transplant clinic team or your GP.