The Simultaneous Kidney Pancreas Transplant: You Want to Stick That Where?

Warning: graphic images. Should you ever find yourself in the position of facing a simultaneous pancreas kidney transplant (SPK), make sure you don’t go into it expecting to receive your old, non-functioning organs as a parting gift, to be bronzed and placed next to that fun run participant’s trophy on your mantle.

It may seem that the most logical course of action for this particular transplant procedure would involve just swapping the transplant recipient’s pancreas and one of their kidneys out for the donor organs (the pancreas and one kidney), using the in-place infrastructure to connect everything.

In many SPK procedures, however, this is not the case. In fact, particularly when it comes to the kidneys, there are folks walking amongst us that have as many as four or five of them lovingly (and surgically, of course) tucked and/or crammed into whatever crevice the human torso allows them to be placed in.

A donor kidney on its way to the recipient. (Dr. Rasu Shrestha)

For the majority of patients undergoing this procedure, many of whom are long-term Type 1 diabetics having to inject insulin to make up for their pancreas not producing it naturally or have varying degrees of renal failure necessitating a new kidney in order to avoid dialysis, exposing the body to the extra surgical steps it would take to remove the damaged organs is simply too risky an option.

By not removing the old organs, surgeons eliminate the need to expose the recipient’s body to any additional stresses. Post-procedure the patient will be on a heavy dose of immunosuppressants for the rest of their life that stop the body from attacking the transplanted organs. Also, avoiding unnecessary incisions that might possibly become infected and lead to complications post-surgery is vital to the procedure’s success.

The transplanted pancreas is attached. (Veronique LaCapra)

Instead, the recipient has the new-to-them kidney and pancreas (harvested from a deceased donor, always the protocol when the pancreas is involved) at the front of their abdomen on either side of their navel just above the pelvis. Although every transplant recipient’s case is different, it is common for the donated kidney to be placed in the patient’s lower left abdomen, attached by the new kidney’s vein and artery.

Since the new kidney’s primary function is to help the body filter waste and extra water from the bloodstream by morphing it into urine, its ureter is also used to connect to the donor’s bladder.

Illustration courtesy the Mayo Clinic.

The donor pancreas’ new home is the recipient’s lower right abdomen where it is connected to blood vessels while the donor’s duodenum (part of the small intestine) is used to attach the pancreas to the recipient’s intestine or bladder. If the transplant surgery goes well and without complications the patient can find themselves out of the operating room in approximately 6-7 hours, the proud owner of three kidneys and two pancreases.

But possibly not an appendix. Because of where the new pancreas ideally has to be situated in the abdomen, the recipient’s appendix-considered in this situation expendable since humans aren’t eating much tree bark these days-may need to be removed, a far less complicated procedure than pancreas removal and attachment.

If all goes well for the patient, their old organs stay where they are, and sometimes even continue to help out where they can in a limited capacity. The kidneys may still be able to filter some waste or excess water from the blood and the pancreas, while not being able to produce insulin, can still manufacture digestive enzymes. All of this buys the recipient of a kidney pancreas transplant approximately 10-12 years of injected insulin and dialysis-free living.