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The Multi Organ Transplant Program of the Toronto General Hospital began performing pancreas/kidney transplants as well as pancreas after kidney in 1995 to meet the organ transplant needs of diabetic patients with end-stage renal failure. Approximately 15 patients per year receive pancreas/kidney transplants. Indications Although dialysis is a life saving treatment, it does not replace all the complicated functions of real kidneys. Similarly, insulin injections do not replace normal pancreas functions of insulin production and regulation. Complications from diabetes and kidney failure can still occur and progress. A successful transplant, however, is able to perform these functions, hopefully restoring all kidney functions and insulin production. For this reason, a pancreas/kidney transplant offers the most advantages over other treatment options. Assessment Pre-transplant evaluation consists of a variety of medical tests and interviews with members of the transplant team. This process is essential in determining a patient's suitability for liver transplant. During the evaluation process the potential candidates and their family will be provided with information to assist them in making informed decisions about the operation and post-operative period. The patient and their family are encouraged to ask questions of the team members and meet the candidates awaiting transplant as well as those having received a liver transplant if possible. The workup process typically involves the following tests, but may require additional testing if other health issues are of concern:
The Transplant Team Members who consult on kidney transplant evaluation are:
Waiting List There are presently over 50 patients on the waiting list for pancreas/kidney transplant within our program. The waiting period for a donor varies in length because the donor pool is limited and the selection criteria for a matching donor are strict. Patients can expect to wait up to 24 months, but most patients are transplanted within 6-18 months. Surgery Pancreas/kidney transplant surgery takes approximately 6 hours. During this operation the donor kidney is inserted and attached through an incision in either the right or left lower abdomen. The surgeon attaches the artery and vein of the new donor kidney to the iliac artery and vein, then attaches the ureter to the bladder. The recipient's kidneys remain in place. The donor pancreas is placed within the abdomen and attached to either the bowel or bladder. Recovery Pancreas/kidney transplant recipients can expect to be in the hospital for approximately 2-3 weeks after surgery. After the transplant procedure, patients are usually monitored in the ICU for 12 hours. Once stabilized, patients are then transferred to the Multi Organ Transplant Unit. Patient care following transplantation focuses on:
Discharge & Follow-up Discharge planning begins well in advance and patients meet with a social worker during their initial assessment to addressing these issues early. The program's Patient Resource Coordinator assists in assessing patients' readiness for discharge and ensuring patient teaching is complete. Patients will return to the Ambulatory Care regularly after the initial postoperative period, with the frequency of clinic visits reduced as the patient's condition permits. During clinic appointments, patients are seen by their Transplant Coordinator, and Transplant Physician. Communication with the patient's family physician and other specialists is an important component of follow-up care. Patients keep in contact with their transplant team through our patient voicemail system, Easy Call. The Multi Organ Transplant Program's team approach ensures that patients receive comprehensive follow-up care after transplantation and throughout their lives post-transplant.
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