Longer-term risks of a pancreas transplant

Infections are very common in the months and years following a pancreas transplant.

The most common infections are chest or urine infections. These are usually fairly straightforward to treat with antibiotics.

Some infections come from the donor pancreas

The most common of these is a virus called CMV (cytomegalovirus). This virus infects more than half of healthy people and, after the initial infection, remains dormant in the body for the rest of your life.

Learn more about the risk of infections

Learn the risks from the donated pancreas

Out of 100 patients, between 10 and 15 will experience rejection within the first year of a pancreas transplant.

The risk of rejection is highest in the first 3-6 months after a transplant. After this time, your body’s immune system is less likely to recognise the pancreas as coming from another person. Even if you take your anti-rejection medications, rejection can still occur. This is why it’s important to keep your clinic appointments, and to take the tablets that have been prescribed for you.

Learn about rejection and pancreas transplants

This happens in 5 to 9 out of 100 patients.

This is an area of weakness in your tummy muscle layers where the pancreas has been implanted. This occurs if the deep layers of the scar don’t heal properly. A hernia is not usually dangerous, but sometimes needs further surgery.

Many patients with hernias through the pancreas transplant scar have few symptoms, though the hernia can be unsightly. If there is a lot of discomfort, or if the hernia stops you from doing daily activities, surgery might be needed. The transplant surgical team can advise you.

Wound healing in transplant patients is not as fast as wound healing in other patients. This is because of the effect of diabetes, and because the immunosuppressant tablets also slow down wound healing. Being overweight or obese, smoking, and too much heavy lifting soon after the transplant can also increase the chance that a hernia might occur. 

After you have had a pancreas transplant, you should avoid heavy lifting (anything over 10kg weight) for at least 6 weeks after surgery. Please speak to the transplant team if you need further advice. If your job requires heavy lifting, you will need to speak to your surgical team about when it is safe to return to your usual duties.

Repair of the hernia requires further surgery, and often needs a mesh to be inserted into your tummy wall to strengthen the wound. Hernias can come back again, even after repair.

This happens in between 1 to 5 in 100 patients.

The join between the pancreas transplant artery and your own artery might become scarred and narrowed. This is known as vascular stenosis. If the blood supply to the pancreas is reduced, and is causing problems with the pancreas, this scarred area might need to be stretched. This will help improve blood flow to the transplant. This usually doesn’t require further surgery, but can be done by X-ray specialists (interventional radiologists) using wires and balloons inside the blood vessels.

Heart problems affect between 1 to 5 in 100 patients.

Heart problems can occur many months after the pancreas transplant. These problems may be due to a blockage in the blood supply to the heart (‘heart attack’). 

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.

What you can do

It is important to stop smoking, take regular exercise, keep a healthy body weight, and have good blood sugar and blood pressure control. Doing these things will reduce the risk of a heart attack.

This happens in between 1 to 3 in 100 patients.

This can cause bleeding within the tummy (abdomen) or bleeding into your intestines. If you have severe tummy pain, blood in your bowel motions (stool), or if you collapse, it is important that you seek medical attention and tell the doctors and nurses that you’ve had a pancreas transplant. They should contact your transplant team to get further advice.

This affects fewer than 1 in 100 patients.

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

What you can do

It is important to stop smoking, take regular exercise, keep a healthy body weight, and have good blood sugar and blood pressure control. Doing these things will reduce the risk of a stroke.

There is a higher risk of some types of cancer following a transplant.

Skin cancers are particularly common in transplant patients. Other cancers, such as lymphomas, are also more common in transplant patients.

What you can do

• Avoid skin cancers by staying out of the sun. If you can’t avoid being in the sun, wear factor 50 sunblock and a long-sleeved shirt and a hat.
• It is strongly recommended that you attend any cancer screening tests, such as a mammogram, cervical smear or bowel cancer screening.
• If you notice a lump, something unusual on your skin or anything else that you’re worried about, please let your transplant team know.

You will need to take powerful medicines after a pancreas transplant.

You may experience side effects to your transplant medicines. Different pancreas transplant centres use different medicines to prevent rejection and infection in their patients. Your own transplant centre will tell you about the medicines they will prescribe after your transplant, and the most common and most important side effects that you need to know about. 

In general, medicines for pancreas transplant patients include:

Immunosuppressants

To reduce the risk of pancreas rejection

The doses of these medicines usually reduce over time, but some medicines will be needed for the lifetime of the pancreas transplant. All immunosuppressants increase the risk of infection, and of some cancers.

Antibiotic and antiviral medicines

To reduce the risk of infection.

These usually stop between 3 and 12 months after a transplant, but your transplant team will advise you about this.

• Medicines to lower blood pressure or reduce the risk of blood clots 

• Medicines to protect the lining of your stomach, as some immunosuppressants and blood thinners can cause stomach irritation 

• Medicines that you may need for other health issues 

Learn more about medicines after a pancreas transplant

89 out of 100 patients are alive 5 years after a pancreas transplant.

There is a risk of dying following a transplant. This risk is highest in the first few weeks or months after the operation. Once you have recovered from the physical stress of the operation, there are still risks of heart attacks, strokes, infections, and cancers. Overall, between 2 and 4 patients out of every 100 will die within the first year after the transplant.

The risk of dying is different for different patients. The risk is higher in older patients, and in those who have serious heart, lung, blood vessel or liver disease and those who have previously had cancer or major infections.

It is important to remember that your transplant team won’t recommend that you have a pancreas transplant if they believe that the risk of the operation is higher than the benefits. If your pancreas transplant team think that you have a higher than average risk of dying following a transplant, they will talk to you about this.