Pancreas transplant surgery

Find out what happens during the transplant operation

Key points

Pancreas transplant surgery by itself takes 2-4 hours
Simultaneous pancreas and kidney (SPK) transplant surgery takes 4-8 hours or more
You will be put to sleep under a general anaesthetic while the transplant takes place
There are many different ways that a pancreas can be transplanted
Your surgeon will explain their preferred technique

How is pancreas transplant surgery performed?

There are many different ways that a pancreas can be transplanted. The surgical team caring for you will explain their preferred technique, and which would be best for you. Most of the time, the pancreas is placed within your tummy cavity (peritoneal cavity). Your own pancreas does not need to be removed.

View an example of a pancreas transplant surgery technique

How it works

Where the pancreas is in the body

Your pancreas is part of the digestive system. It is about 6 inches long and sits in the top of your tummy (abdomen), behind the stomach. It is connected to your small intestine through a small tube called the pancreatic duct. It is surrounded by your spleen, liver, gall bladder and bile duct.

Illustration showing the positions of the pancreas, spleen, liver, gallbladder and bile duct within the body

Close up of a pancreas

This is a close up view of a pancreas. The main pancreatic duct runs through the length of the pancreas and attaches to the small intestine (pink). The part of the small intestine that attaches to the pancreas is called the duodenum.

Illustration of pancreas showing positions of pancreatic duct and small intestine

Connecting a donor pancreas

Most of the time, a donor pancreas is placed within your tummy cavity (peritoneal cavity). Your own pancreas does not need to be removed. The donor pancreas is transplanted with a short piece of donor small intestine (the duodenum). This is joined to your small intestine or sometimes your bladder.

Illustration showing how a donated pancreas connects to a patient via the small intestine

Close up of a pancreas transplant

This shows a close up of a pancreas transplant and its typical connection points - the intestine (pink) the pancreas portal vein (blue) and pancreas artery (red). The pancreas artery usually needs to be reconstructed during a transplant.

Illustration of a pancreas transplant, showing the join between the donor and recipient intestine, pancreas transplant portal vein and reconstructed pancreas transplant artery

Some things that will happen during pancreas transplant surgery

You will be given a general anaesthetic

Joins will be made between your blood vessels and those of the donated pancreas

The blood vessels near the back of your tummy will be found, and joins will be made between the blood vessels of the pancreas and your blood vessels. There is usually one join for the vein, and one join for the artery. Blood flow through these vessels will be temporarily stopped while the stitching is being done. Once the blood vessels have been stitched together, blood will be allowed to flow through the pancreas.

Joins will be made between the piece of intestine attached to the donated pancreas, and your intestine (or bladder)

Once the blood vessels have been stitched together, blood will be allowed to flow through the pancreas. If the surgeon is happy with the blood flow, they will then make a join between the piece of intestine attached to the donated pancreas, and your intestine.

This join carries the special chemicals called enzymes that are produced by the pancreas that help digest food. These chemicals (enzymes) are usually not needed to make you better, as the aim of the pancreas transplant is usually to improve your blood sugar control and not to change your gut function.

Sometimes the surgeon may attach the piece of intestine attached to the donated pancreas to your bladder, instead. The enzymes will be carried in your urine, instead.

Tubes will be inserted into your neck, arms and bladder

When you’re asleep, you’ll have plastic tubes (lines or catheters) inserted into your neck, arms and bladder. Before the operation, the surgical and anaesthetic teams will explain where the tubes will be placed.

What are the tubes for?

Small tubes (lines) are inserted into your arms to enable fluid and medications to be given to you during and after the surgery.

For most pancreas transplant operations, you’ll also have a tube inserted into the veins in your neck so that stronger medications can be given, if needed. This also lets the team looking give you extra fluid, if needed.

A tube (catheter) will be inserted into your bladder via the urethra. Most pancreas transplant surgeons will also insert a larger plastic tube into the area around the pancreas transplant to drain away any tissue fluid after the surgery.

Risks

Inserting tubes into you can lead to bleeding, infection, or damage to other structures such as blood vessels or nerves. These complications are very rare.

If you have an SPK transplant, a biopsy of the donated kidney might be taken

Some surgeons will take a small piece of tissue (biopsy) of the donated kidney. This can happen when the kidney arrives in your transplant centre, or after the kidney has been transplanted.

Risks

Taking a kidney biopsy is usually very straightforward, but can rarely lead to bleeding from the kidney or damage to the kidney. The risk of serious bleeding or kidney damage from the biopsy is less than one in 100.

Why is a biopsy done?

A kidney biopsy might be taken for research (for example, to find better treatments).

Removal of peritoneal dialysis (PD) catheter