About Pancreas-Kidney Transplant

Overview of Pancreas-Kidney Transplant

First established in 2012, the Pancreas Transplant program is a collaborative effort with the National University Hospital Singapore to establish pancreas transplantation in Singapore. This provides an addition treatment option for patients who suffer from Type 1 diabetes. The first simultaneous kidney and pancreas transplant in Singapore was successfully carried out on September 2012.

The main objectives of pancreas transplant are to render Type 1 diabetes patients from being insulin-dependent, to improve quality of life and to reduce long-term diabetic complications. It has been shown to prolong survival in patients with diabetes and renal failure. Pancreas transplant has been performed for over 4 decades and is a well-established procedure in diabetic patients.

To date, more than 30,000 pancreas transplants have been reported to the International Pancreas Transplant Registry (IPTR), with more than 22,000 from the USA and more than 8000 from outside the USA. The 1-year graft survival rates now exceed 80%, and the 1-year patient survival rates are 95%. The 3-year patient survival rates exceed 90%, and the 3-year pancreas graft survival is about 80% for simultaneous pancreas kidney recipients. The 5-year pancreas graft survival rate is 72% and patient survival rate is 86%, compared to a dismal 5-year patient survival of 38% without transplant in Singapore.

Scenarios for Pancreas Transplant

Pancreas transplant is performed in 3 possible scenarios:

1. Simultaneous Pancreas Kidney transplant (SPK)

The most common scenario is a SPK transplant, which is indicated in Type 1 diabetics who are already on dialysis. For SPK transplants, the rationale for a simultaneous pancreas and kidney transplant is that such patients are obligated to immunosuppression for renal transplant and the same source donor is utilized for pancreas graft minimizing tissue incompatibility.

2. Pancreas After Kidney Transplant (PAK)

PAK transplant is indicated in patients with stable function of previous renal allograft that meet the criteria of pancreas transplant alone.

3. Pancreas Transplant Alone (PTA)

PTA is indicated in Type 1 diabetics who have significant diabetic complications or have life-threatening complications such as frequent and severe episodes of hypoglycemia or have hypoglycemic unawareness.

Who is eligible for pancreas transplant?

Patients are deemed suitable if they are below 55 years old and have:     

• Type I diabetes mellitus
• ESRD on renal replacement therapy
• Are eligible to be put on the cadaveric kidney transplant wait list

Potential SPK recipients should qualify for pancreas transplant after assessment that they have Type 1 diabetic physiology, and qualify for kidney transplant independent of the pancreas (i.e. be on dialysis).

For pancreas transplant alone, the indications will include hypoglycemic unawareness, frequent or severe hypoglycemic attacks and can be performed as pancreas transplant alone (PTA) or pancreas after kidney transplant (PAK).

Singapore Pancreas Organ Allocation

• Pancreas transplant is almost always done with cadaveric sourced organs. At present, the Human Organ Transplant Act (HOTA) does not mandate pancreas donation and it is covered under Medical Therapy Education and Research Act (MTERA). When consent is obtained, the donation process will proceed together with other organs deemed suitable for transplant.
• Patients who require simultaneous pancreas kidney transplant will receive priority transplant, due to their mortality risk without transplant. This would mean they could likely to have shorter waiting times compared to patients who require a kidney transplant only.