Rejection of a transplanted pancreas

Rejection is when your body’s immune system starts to ‘attack’ your transplanted organ. It happens when your immune system recognises the organ as coming from a different person.

Rejection can still occur even if you’re taking all of your medicines. If you don’t take your medications as prescribed, the risks of medicines are higher. It’s very important to take all of your tablets exactly as they are prescribed for you.

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

Some patients have a higher risk of rejection than others. If you have had a previous transplant, a blood transfusion, or a pregnancy you may have produced defence proteins (‘antibodies’). These antibodies can increase the risk of rejection.

If transplant rejection is picked up early, it can often be treated successfully. It is possible for rejection to cause the pancreas to fail completely.

Pancreas rejection can cause tummy (abdominal) pain or raised blood sugars. If you’ve had a simultaneous pancreas and kidney (SPK) transplant, kidney rejection can cause you to pass less urine or have pain over the kidney transplant.

Rejection is suspected when your pancreas starts to work less well. In other words, when blood sugars or pancreas enzyme levels rise. If you’ve also had a kidney transplant, rejection of the kidney causes the creatinine in your blood to rise and can eventually lead to a drop of urine production.

Diagnosis usually requires a sample of the organ tissue to be removed with a needle (a biopsy) to look at under a microscope.

A biopsy is usually done using local anaesthetic to numb the skin. There are risks of bleeding and damage to the transplant, but these are rare. Your transplant team will explain the risks of having a biopsy to you.

Your health, and the health of your new organ, will be closely monitored in clinic

Treatment is with stronger immunosuppressant medicines. 

If the transplant rejection is picked up early, it can usually be treated successfully. It is possible for rejection to cause an organ to fail completely, but this is unusual.

The treatment will depend on the type of rejection you have.

There are different types of rejection, depending on which parts of the immune system are attacking the organ. Different types of rejection need different treatments.

Cellular rejection

The most common type of rejection is called ‘cellular’ rejection. This can usually be treated by giving steroids into your vein. Sometimes more powerful treatment is required and this will usually require a stay in hospital. The steroids can lead to a rise in your blood sugars.

Defence protein rejection

Less commonly, but more seriously, defence proteins (‘antibodies’) cause rejection. This type of rejection is difficult to treat and you will need to come into the hospital for treatment. Your transplant team will explain this to you in more detail.

Make sure you attend all of your appointments in clinic, and take the medicines that have been prescribed for you. If you have side-effects from your anti-rejection medicines, tell your transplant team so that they can talk to you about other options. Do not stop taking your immunesuppressant (anti-rejection) medicines.