Early risks of a pancreas transplant

Out of 100 patients, between 30 to 50 will need a blood transfusion within the first week of surgery.

With any operation there is a risk of bleeding. If it happens during the operation, the surgeon can usually stop it with extra stitches or special medications. Patients who take blood-thinning medications (for example, warfarin) have a higher risk of bleeding.

Sometimes, patients who have had a pancreas transplant will need to go back to the operating theatre for more surgery to stop the bleeding, as well as having a blood transfusion. This is also common.

A blood transfusion carries risks such as fluid overload, production of antibodies, or (very rarely) disease transmission. Your transplant team will discuss these with you.

This occurs in 30 out of 100 patients. You may need further surgery within the first few weeks or months after the pancreas transplant. There are many different reasons why further surgery might be needed.

1. The pancreas transplant is not functioning as well as expected

Out of 100 patients, between 5 and 10 will require further surgery to find out what’s going on.

2. Blockages of the intestine

Out of 100 patients, between 2 to 5 have a blockage of the intestine. This may be due to a twist in the intestines, or scar tissue narrowing them. Sometimes a hernia (muscle weakness) can occur and intestine can be trapped inside the hernia.

3. Tissue fluid can build up around the pancreas

Out of 100 patients, between 5 and 10 get fluid build up around the pancreas.  Sometimes the fluid can become infected. Surgery may be needed, or your transplant team may ask the special X-ray team (interventional radiologists) to place a draining tube into the fluid collection.

4. Wound infections or bleeding into the wounds

Sometimes this might require further surgery.

5. Other organs damaged during the transplant operation

This happens to between 2 to 5 patients out of every 100 transplants. Sometimes further surgery is needed to repair other organs damaged during the transplant operation. This might include damage to the intestines (bowel) or liver or spleen, or to the blood vessels leading to and from the leg.

If the blood supply to the leg is severely damaged, it is possible that the leg on that side may no longer work, or you may need another operation to repair the blood vessels or even to remove the leg (amputation). This is uncommon (fewer than 1 in 100 patients).

Between 10 and 20 patients out of 100 will require antibiotics for an infection within the first week of pancreas transplant surgery.

Infections are common after a pancreas transplant, in part because you will be given immune suppressing medicines. These medicines reduce the risks of you rejecting the donated pancreas, but they will also lower your immune system’s ability to fight infections.

Most infections are easily treated with a few days of antibiotics. Infections can occur in your chest, tummy, urine, around the plastic tubes inserted through your skin, or in your surgical wound.

More serious infections can spread to your blood stream. Sometimes, if there is infected fluid around the pancreas transplant or in the wound, you might need to go back to the operating theatre to have the fluid washed out.

Learn more about the risk of infections

For every 100 simultaneous pancreas and kidney (SPK) transplants, between 10 and 20 patients will develop delayed graft function.

Delayed graft function is when your transplanted kidney doesn’t start working straight away.

After a SPK transplant from a deceased donor, it can take a few days, or even a few weeks, for the kidney to ‘wake up’ and start working. This is very common and is called ‘delayed graft function’. The majority of kidneys do eventually ‘wake up’ but you may need dialysis while you are waiting for this to happen.  

It is very rare for the transplanted pancreas to be slow ‘waking up’.

Learn more about delayed graft function

Rejection happens in between 10 to 15 in every 100 patients during the first year after a transplant.

Rejection is when your body’s immune system starts to ‘attack’ your transplanted pancreas (or kidney). It happens when your immune system recognises the organ as coming from a different person and thinks it isn’t supposed to be there.

After a pancreas transplant, patients need to take powerful medications (‘immunosuppressants’) to help stop rejection happening. Even if you take your anti-rejection medications carefully, rejection can still occur. This is why your transplant team will closely monitor your transplant and health after the operation.

Learn more about rejection

This happens to between 5 to 10 patients out of every 100 transplants.

This leak usually comes from the join between the piece of donor intestine attached to the pancreas and your intestine (or bladder).

Leakage of fluid can be repaired surgically. Sometimes if the leak is severe, or you are ill from the leak, the best treatment is to remove the transplanted pancreas completely. Your transplant team will discuss these options with you.

If the transplanted pancreas needs to be removed, sometimes your own intestine can’t be repaired safely. A loop of your intestines may need to be brought to your skin surface to drain away intestinal contents. This is called a ‘stoma’. It can usually be reversed about six months after the transplant.

If the transplanted pancreas has been attached to your bladder, a leak can be treated by re-insertion of a catheter (tube) into the bladder.

This happens in between 3 to 5 patients in every 100 pancreas transplants.

A blood clot can form within the artery leading to the pancreas, or the vein draining blood from the pancreas. This might require emergency surgery, or you might go to special X-ray (interventional radiology) to have a thin wire put inside your blood vessels to remove the clot.

If a blood clot forms within the blood vessels of the pancreas it can be very difficult to successfully treat. Often the pancreas transplant needs to be removed completely.

Some patients are prone to forming blood clots. These patients are at increased risk of blood clots within the pancreas and are likely to need medication to keep their blood thin after the surgery.

This happens in between 2 to 4 patients out of 100 pancreas transplants.

Sometimes a transplanted pancreas or kidney never works. If this happens, your transplant team might recommend that the pancreas or kidney be surgically removed.

There are many reasons why a transplant might never work (also called ‘primary non-function’). These reasons include:

• A blood clot within the blood vessels that leads to or from the transplant
• Severe early rejection of the organ, which is resistant to anti-rejection treatment
• Sometimes it is not possible to know why the organ never worked

If the pancreas transplant stops working, or if it never works, you’ll need to start taking insulin injections again.

This happens in 1 to 5 patients out of 100 pancreas transplants.

Nerves around the area of the transplant may be damaged during the surgery.

A patch of numbness on the front of the thigh on the same side of the transplant is common, but this almost always gets better by itself.

Weakness to the nerve that controls the muscles around the knee is more serious, but much less common (about one in every 1,000 patients).

Heart problems affect 1 to 5 patients out of 100 pancreas transplants.

Heart problems can occur soon after the pancreas transplant. This may be due to a blockage in the blood supply to the heart (‘heart attack’) or problems with the rhythm of the heartbeat.

If your doctor thinks you might be at risk of major heart problems, they’ll test your heart function before you go on the transplant list.

• Even if your heart tests are normal, it is still possible that you may have heart problems after the pancreas transplant due to the stress of the operation.
• A heart attack happens when there is a blockage in the blood supply to the heart muscle. This usually happens when there is thickening inside the walls of the heart arteries.
• Good treatments are available for both a heart attack, and for problems with the heart rhythm. These treatments include blood thinning medication, or medications to settle the heart rhythm. Sometimes heart doctors (cardiologists) may need to place tubes into the heart arteries to try to unblock them. Sometimes a pacemaker might be needed.

This affects fewer than 1 in 100 patients.

A stroke (a blockage of the blood supply to the brain) can happen early after a transplant. Strokes are more common in older patients, and in those who have had a stroke before.

Rarely, there can be a blockage to the blood supply of the spinal cord. This could lead to paralysis of the legs or arms. This might happen in about 1 in 400 pancreas transplant patients.

About 1 in 100 patients experience deep vein thrombosis.

Blood clots can form within the deep veins of the leg. These clots can break off and travel in the bloodstream to the hearts, causing lung and heart problems. Blood clots in the deep leg veins are called a deep vein thrombosis (DVT). If they travel to the lung it is called a pulmonary embolus (PE).

How your transplant team aim to prevent DVT:

• You will be encouraged to get out of bed as soon as you can after a pancreas transplant to reduce the risk of these blood clots forming.
• Tight stockings help reduce the risk of DVTs and PEs. These should be worn while you are in hospital, and until the transplant team tell you that it is safe to remove them. Some patients should not wear tight stockings, for example if you have major blood flow problems in your leg arteries.
• Blood-thinning medication is usually given to patients after a pancreas transplant to reduce the risks of DVTs and PEs. However, these blood thinners can increase the risk of bleeding after surgery so a balance needs to be found.

This might happen in about 1 in every 200 attempted pancreas transplant operations.

Sometimes the pancreas transplant operation starts, but the surgeon is unable to complete the transplant. This is uncommon.

Reasons for this include:

• Serious anaesthetic complications that mean it would be dangerous to proceed with surgery (for example, reactions to the anaesthetic or other medications, or serious heart or lung problems)
• Major bleeding that cannot be controlled unless the transplant is removed
• Severe diseases of the arteries or veins that mean that connecting them to the pancreas transplant is dangerous
• Serious problems with the blood flow within the pancreas transplant that mean the pancreas has to be removed during the same operation
• Severe rejection of the pancreas that cannot be treated during the operation
• New information about the deceased donor or pancreas that was not available before the operation started (for example, finding a cancer in the donor)

This happens in fewer than 1 in 1000 patients.

It is rare to get a serious infection such as hepatitis B, hepatitis C or HIV from a pancreas transplant. It is more common that less serious infections such as cytomegalovirus (CMV) are passed on – this infection is usually straightforward to monitor, diagnose, and treat.

Learn about the risks from a donated pancreas

Learn more about infections

Fewer than 1 in 1000 patients will get cancer from a donated liver.

It is very rare for cancer to be transmitted with the donated pancreas. Every effort is made to be sure that a donor does not have a cancer that could be passed on to you during a pancreas transplant. The risk of dying while waiting to receive a pancreas transplant is much greater than the risk of getting cancer from a transplanted pancreas.

You may be offered a pancreas from a donor known to have had cancer. This will only happen if the transplant team think that the risk of the donor’s cancer having spread to the pancreas is low. This often is the case with some kinds of cancer that are confined to the brain. This will be discussed in detail with you. The risks of getting cancer from these donors is usually higher than 1 in 1000.

The average risk of dying during the first few months after a pancreas transplant is between 1 to 3 in 100. However, this varies widely on a patient-by-patient basis. 

There is a risk of dying during the pancreas transplant operation, or during the first few weeks or months afterwards. This is usually due to the stress of the surgery on your heart and lungs, or because of serious complications such as infections, heart attacks or strokes. 

Each patient has a different risk of dying after the operation. The risk of dying is higher in older patients, and in those who have major heart, lung, blood vessel or liver disease. The risk of dying in the first few months after a pancreas transplant can be as low as 1 out of every 1000 patients, or as high as 1 out of every 20 patients. If your transplant team believe that you have a higher than usual risk of dying after a pancreas transplant, they will talk to you about this.

It is important to remember that your transplant team won’t recommend that you have a pancreas transplant if they believe that the risks of the operation are high.