Overview

A simultaneous pancreas-kidney (SPK) transplant is a treatment for patients with kidney failure and insulin-dependent diabetes. The kidney and pancreas are removed from a person who has died (a deceased donor) and given to the person who needs it (the recipient).

The transplanted pancreas produces the insulin that the recipient needs, and responds to the recipient’s own blood sugar levels. The pancreas also produces enzymes, which are chemicals that break down tissues. Your body does not usually need the extra enzymes. The transplanted pancreas is joined to your blood vessels and intestines. These enzymes flow into your gut, and pass out of your body.

There are other treatments, but a SPK transplant is usually the best treatment for patients who have kidney failure and insulin-dependent diabetes who are well enough for the operation. A SPK transplant is major surgery and should be considered carefully. The transplant is not a cure, and has risks as well as benefits. 

Benefits of having a SPK transplant

For most patients, a SPK transplant leads to a better quality of life and a longer life. This is because they do not have to rely on dialysis, so they have more freedom to travel, work, and they can eat and drink more freely. Most people say they have more energy and feel more able to cope with everyday activities.

Your sex life and your fertility are likely to improve after the transplant. If you are able to become pregnant, you will usually be able to conceive after a transplant, although we suggest you wait 1 year before trying for a baby.

After the transplant, people can usually control their blood sugar well. They usually will not need to inject insulin and should not have dangerously low blood sugars. Conditions that are caused by diabetes often become stable after having a SPK transplant, and sometimes even improve.

This includes heart and blood vessel conditions, and other conditions caused by diabetes, such as:

• diabetic retinopathy (damage to the eyes)
• diabetic gastroparesis (a gut condition)
• diabetic neuropathy (damage to the nerves) 

Risks of having a SPK transplant

As with any medical procedure, there are risks associated with having a SPK transplant and it is important to understand them.

Some deceased donors will have had long-term health problems before they died. If these could affect you, we will discuss them with you before your transplant.

Some of this information may be worrying, but it is better for you to understand the potential risks, as well as the potential benefits, of having a SPK transplant. Everyone’s situation is different. We will talk to you about the risks and benefits before a decision is made about adding your name to the national transplant waiting pool (list).

Delayed kidney function

About 75 out of 100 kidney transplants from deceased donors start to work within a few hours of surgery.

Sometimes the new kidney will not start working within a few hours. This is known as delayed graft function, or sleepy kidney. If this happens, you will need dialysis until the new kidney starts working. This may be for a few days, or sometimes a few weeks.

You will need regular ultrasound scans of the kidney, and may need a kidney biopsy. This is when a tiny piece of tissue is removed from your kidney, and examined under a microscope, to make sure that there are no other problems with the kidney.

Infection

After a SPK transplant, you might get an infection in your chest, surgical wound, tummy (abdomen), or a urinary tract infection (UTI). This can usually be treated with antibiotics, but sometimes another operation is needed.

Bleeding

Bleeding that needs a blood transfusion happens in 50 to 60 out of 100 SPK transplant patients. Up to 15 of these patients might need another operation to stop the bleeding. If you are taking blood-thinning medicines such as warfarin, you are more likely to need a blood transfusion and to need another operation.

More surgery

Another operation may be needed for bleeding, infection, or to rule out any problems with the first operation. Between 30 and 40 out of 100 SPK patients need more surgery after the transplant.

Up to 15 out of 100 patients develop a hernia or weakness in the transplant scar and may need an operation to repair this.

About 4 to 6 weeks after the transplant, you will need to have a small operation to remove the plastic tube (stent) that has been placed between your new kidney and your bladder.

Sometimes, more surgery is needed months or years later if there are any complications.

Rejection

Sometimes your body may start to attack the kidney or pancreas, because it recognises that they have come from another person. This process is called rejection. Between 10 and 20 out of 100 patients who have had a SPK transplant will have an episode of rejection during the first year.

Rejection is diagnosed by taking a sample of kidney or pancreas tissue to look at under the microscope (a biopsy). Usually, rejection can be treated by increased doses (amounts) of immunosuppressant medicine. 

Risks of immunosuppressant medicines

You will need to take medicine to suppress your immune system during the whole time that the SPK transplant lasts. This medicine has side effects including an increased risk of infection and, in the longer term, cancer (particularly skin cancer).

Other side effects include a higher risk of high blood pressure, and high cholesterol, which is a fatty substance found in the body that can cause narrowing of the blood vessels.

While you are in hospital, the transplant pharmacist will talk to you about these possible side effects. They will also tell you how to monitor and manage them, such as using a high-factor sunscreen to lower the chance of skin cancers. At your transplant follow-up appointments, we will check your blood pressure, cholesterol and blood sugar.

Conditions passed on from the donor

In rare cases, the transplanted organs may carry conditions such as cancer or infection. All deceased donors are tested for infections and for signs of cancer. It is very rare that serious conditions are passed on (less than a 1 in 1,000 chance). Your doctor will discuss this with you before your transplant.  If you think that the risks are too high, you can decide not to have the transplant. This will not affect the rest of your treatment and you will not lose your place in the transplant pool.

Other infections, such as cytomegalorovirus (CMV), are very common. They can often be passed on from transplanted organs, but cause little, or no long-term harm. You might need to take medicine to reduce the risk of these milder infections. We speak to you about this at the time of your operation.

If the transplant does not work

Sometimes, organs that have been transplanted never work. This happens in 3 to 5 out of 100 pancreas transplants, and in 2 to 3 out of 100 kidney transplants. The failed transplant will then need to be removed by a surgeon. Your own pancreas and kidneys will not be removed, and will stay in the same place. 

Sometimes the transplanted pancreas may work for a few days or weeks, but then stop working. This may be due to blood clots within the pancreas, or if the pancreas becomes inflamed. Occasionally, the pancreas may be working, but might have to be removed due to infection or leakage of enzymes.

Overall, 5 to 10 out of 100 transplanted pancreases need to be removed within the first year.

Other risks

Between 1 and 2 patients out of 100 develop a blood clot in the legs or lungs after having a SPK transplant. Heart attacks or strokes happen in 3 to 5 out of every 100 patients after the transplant. However, in the long term, your risks of heart attacks or strokes are likely to be reduced by having the transplant. 

Very rarely, the blood supply to the spinal cord or legs is damaged as a result of the transplant operation. If the blood supply to the legs is very poor, amputation (removal) of the leg might be needed. Amputation is more likely if you already had poor blood supply to your legs before the transplant. Up to 2 in 100 patients have this problem. Problems with the blood supply to the spinal cord are very rare (about 1 in 500 patients), but could lead to leg paralysis.

Rarely, the blood vessels supplying the pancreas become swollen, or bleed into other organs. These problems cause tummy (abdomen) pain, back pain, or bleeding into the bowel. This happens in 1 or 2 in 100 patients, and will need major surgery to fix it. This can happen in a pancreas transplant that is working well, or even after the pancreas has stopped working or has been surgically removed.

If the transplanted pancreas needs to be removed, your own intestines will need to be repaired at the site where the transplanted pancreas was attached.  

If the surgeon feels that it is unsafe to try to repair your intestines, they will need to bring your intestine out to your tummy (abdomen) wall. This is called a stoma. This happens in 2 to 4 out of 100 patients after having a SPK transplant. Fluid from your intestines will be emptied into a bag that is attached to your tummy wall. This is not permanent, and more surgery will be needed 4 to 6 months later to remove the stoma and repair your intestines.

Survival

Sadly, 4 to 6 out of 100 patients will not survive the first year after SPK transplant surgery. This may be because of complications from the surgery, the immunosuppressant medicine, or other health issues.

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead with the treatment, you will be asked to sign a consent form. This states that you understand what the treatment involves and agree to have it.

You can read more about our consent process.

Other treatment options

If you have kidney failure, you must have specialist treatment to keep you alive. Your kidney care team at your renal centre will have discussed the different types of treatment with you. Other treatment options include:

Live donor kidney transplant

A kidney transplant from a living (live) donor is a very good option, as the kidney usually starts working immediately. A kidney from a live donor usually works for longer than a kidney from a deceased donor. This is a smaller operation (2 to 4 hours) with less chance of bleeding, needing more surgery, and other major complications. However, for many kidney patients finding a suitable live donor can be difficult. Without a pancreas transplant, you will still have diabetes, and the tablets that you need to take for the kidney transplant might make your blood sugar control worse.

Live donor kidney transplant followed by a pancreas transplant

A pancreas transplant from a deceased donor can be done 12 to 18 months after a live donor kidney transplant. Because the transplanted pancreas and kidney come from different donors, the risks of your body rejecting the pancreas are higher. The average survival of a pancreas transplanted after a live donor kidney transplant is 3 to 5 years. This is less than a pancreas transplanted as part of an SPK transplant, which is 10 to 12 years.

Deceased donor kidney transplant

A deceased donor kidney transplant is when you receive a kidney from a donor who has died. It is a smaller operation, lasting 2 to 4 hours. There is less chance of bleeding, needing more surgery, and other major complications. The average waiting time for a kidney transplant from a deceased donor is 2 to 4 years. Without a pancreas transplant, you will still have diabetes, and the tablets you need to take for the kidney transplant might make your blood sugar control worse. 

Dialysis

Dialysis is a procedure that removes waste products and excess liquid from your body.

Although dialysis will keep you alive, long-term dialysis can result in problems such as hardening of the arteries and thickening of the heart muscle.

There are 2 types of dialysis:

• haemodialysis (HD)
• peritoneal dialysis (PD)

The main complications of HD are associated with getting access to your blood. This is done using either a:

• fistula (where an artery and vein are joined in a small operation)
• graft (a small piece of plastic connects your artery and vein)
• dialysis line (a small plastic tube in your neck) and this may become more difficult with time

The main complication associated with PD is infection in the tummy (abdomen). Rarely, PD patients can develop thickening and scarring of the lining of the tummy. This may be related to staying on PD for many years. 

More information on dialysis can be found on the NHS website. 

Conservative management

This is when you manage the symptoms of kidney failure without dialysis or a transplant, but through receiving support from your healthcare team. This option is for those with a limited life expectancy due to other serious health conditions.

If you have been referred to a surgeon for a possible SPK transplant, this is not likely to be a good option for you.