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Pancreas Transplantation

By Martin Hertl, MD, PhD, Jack Fraser Smith Professor of Surgery, Director of Solid Organ Transplantation, and Chief Surgical Officer, Rush University Medical Center

Pancreas transplantation is done for people who have diabetes if their pancreas cannot make any insulin. More than 80% of people who have diabetes and who receive a pancreas transplant have normal blood sugar levels afterward and no longer need insulin, but they trade this benefit for the need to take immunosuppressants, with the risk of infections and other side effects.

Because injectable insulin is a safe and reasonably effective treatment for diabetes, freedom from insulin is not considered a sufficient reason for pancreas transplantation. Thus, this procedure is usually done only if people with diabetes have one of the following:

  • They also have kidney failure.

  • They cannot keep their blood sugar levels within an acceptable range, particularly if they do not sense when their blood sugar levels become too low.

(Occasionally, when blood sugar levels remain too low for too long, organs, including the brain, are permanently damaged.)

Overall, more than 90% of people who receive a pancreas transplant receive a kidney transplant at the same time. Kidney transplantation requires abdominal surgery and the use of immunosuppressants afterward, so transplanting a pancreas at the same time adds few risks.

Pancreas transplantation may be beneficial for people who are taking insulin but still have high blood sugar levels and whose blood sugar levels become dangerously low after taking insulin.

Sometimes only certain cells from the pancreas are transplanted (called pancreatic islet cell transplantation).

About 90% of people survive at least 1 year after transplantation.


Donors are usually people who have all of the following characteristics:

  • They recently died.

  • They were aged 10 to 55.

  • They had not abused alcohol.

  • They had not had prediabetes (blood glucose levels that are higher than normal but not high enough to be labeled diabetes) or diabetes.

If both a pancreas and kidney are being transplanted, they must come from the same donor.

Parts of a pancreas from a living donor have been used, but this procedure is rarely done because the risks to the donor are high.


The procedure may involve

  • Transplanting a pancreas and kidney at the same time (simultaneous pancreas-kidney transplantation)

  • Transplanting a kidney first, then a pancreas (pancreas-after-kidney transplantation)

  • Transplanting only a pancreas (pancreas-alone transplantation)

Pancreas transplantation is a major operation, requiring a long incision in the abdomen and a general anesthetic. The recipient’s pancreas is not removed.

Typically, the operation takes about 3 hours and the hospital stay is 1 to 3 weeks.

Drugs to inhibit the immune system (immunosuppressants, including corticosteroids, are started the day of transplantation. These drugs can help reduce the risk of rejection.


Transplantation can cause various complications.


Despite the use of immunosuppressants, rejection occurs in 40 to 60% of people after pancreas transplantation (with or without a kidney).

When a pancreas and kidney are transplanted at the same time, the risk of rejection is higher, and rejection tends to occur later and more often than when only a kidney is transplanted. Usually, both organs are rejected.