About Pancreas-Kidney Transplant Programme

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 additional treatment option for patients who suffer from Type 1 diabetes. The first simultaneous kidney and pancreas transplant in Singapore was successfully carried out in September 2012.

The main objectives of pancreas transplant are to render Type 1 diabetes patients’ insulin-independent, 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 8,000 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 5-year patient survival of 38% without transplant in Singapore.

Function of Pancreas-Kidney

The pancreas plays a key role in regulating blood sugar levels by producing insulin. In patients with Type 1 diabetes, the pancreas is unable to produce insulin, leading to lifelong insulin dependence.

A pancreas transplant aims to restore natural insulin production, helping patients achieve better glucose control, improve quality of life, and reduce diabetes-related complications.

When combined with a kidney transplant, the procedure also addresses kidney failure caused by long-term diabetes, allowing both endocrine (pancreas) and renal (kidney) functions to be restored.

Understanding When a Transplant is Needed

Pancreas transplant is performed in three 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 is that such patients already require immunosuppression for renal transplant, and the same donor source is utilized for the pancreas graft, minimizing tissue incompatibility.
2. Pancreas After Kidney Transplant (PAK)
   PAK transplant is indicated in patients with stable function of a previous renal allograft who meet the criteria for pancreas transplant alone.
3. Pancreas Transplant Alone (PTA)
   PTA is indicated in Type 1 diabetics who have significant diabetic complications or life-threatening conditions such as frequent and severe hypoglycemia or hypoglycemic unawareness.

How to Get a Transplant

Eligibility criteria:

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

• Type 1 diabetes mellitus
• End-stage renal disease (ESRD) on renal replacement therapy
• Eligibility to be placed on the cadaveric kidney transplant waiting list

Potential SPK recipients must demonstrate Type 1 diabetic physiology and qualify for kidney transplant independently (i.e. be on dialysis).

For pancreas transplant alone, indications include hypoglycemic unawareness, frequent or severe hypoglycemic attacks, and may be performed as PTA or PAK.

Organ allocation in Singapore:

Pancreas transplant is almost always performed using cadaveric donor organs. Under current regulations, pancreas donation is governed by the Medical Therapy Education and Research Act (MTERA).

Patients requiring simultaneous pancreas-kidney transplant are prioritised due to their higher mortality risk without transplant, which may result in shorter waiting times compared to patients requiring kidney transplant alone.

Conditions We Treat

We care for patients with:

• Type 1 diabetes mellitus
• End-stage renal disease (ESRD)
• Severe diabetic complications
• Hypoglycemic unawareness
• Frequent or severe hypoglycemic episodes

Our Services Include:

• Simultaneous pancreas-kidney (SPK) transplantation
• Pancreas after kidney (PAK) transplantation
• Pancreas transplant alone (PTA)
• Pre-transplant assessment and eligibility evaluation
• Access to cadaveric organ transplant programmes
• Multidisciplinary care to improve quality of life and long-term outcomes

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.