Pancreas-After-Kidney (PAK) Transplant

A pancreas-after-kidney (PAK) transplant is used to treat people who are diabetic after a kidney transplant to prevent any future damage to the new kidney. Following a successful kidney transplant, surgeons transplant a healthy pancreas from a deceased donor into the recipient’s body 

UPMC is among the world’s most experienced transplant programs and offers advanced care for people who need a PAK transplant. Established in 1981, UPMC's transplant program has performed more than 20,000 adult and pediatric organ transplant surgeries, including liver, kidney, pancreas, kidney/pancreas, small bowel, liver/small bowel, heart, heart-lung, double-lung, single-lung, and multiple-organ transplants.

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What Is Pancreas-After-Kidney (PAK) Transplant?

A pancreas-after-kidney (PAK) transplant is used to treat people who are diabetic after a kidney transplant to prevent any future damage to the new kidney. Following a successful kidney transplant, surgeons transplant a healthy pancreas from a deceased donor into the recipient’s body.

Conditions we treat with PAK transplant

• Blood sugar management issues.
• Diabetes.
• Severe hypoglycemia.

Why Would I Need A PAK Transplant?

If you have severe complications related to diabetes or typical treatments aren’t helping to control your blood sugar levels after a kidney transplant, you may need a PAK transplant. Pancreas-after-kidney transplant helps to protect your new kidney from diabetes-related complications.

Who’s a candidate for a PAK transplant?

People who are candidates for PAK transplant have already had a kidney transplant to treat kidney failure and include:

• People with type 1 diabetes who have serious, ongoing complications.
• People with severe hypoglycemia unawareness or severe blood sugar management issues.
• People up to age 55 who are not responsive to other treatments.
• Select individuals with type 2 diabetes.

Alternatives to PAK transplant

• Pancreas transplant alone (PTA).
• Simultaneous pancreas-kidney (SPK) transplant.

What Are the Risks and Complications of PAK Transplant?

Risks associated with PAK transplant may include:

• Bleeding.
• Complications related to immunosuppressive medication.
• Infection.
• Organ rejection.

What Should I Expect From PAK Transplant?

The first step in the process is for your doctor to refer you to UPMC for a pancreas transplant. We also accept self-referrals.

PAK transplant patient information review

After the UPMC pancreas transplant team receives your medical records and information listed on the transplant referral checklist:

• A transplant nurse coordinator will collect your medical history, radiology studies, recent blood work, and current physical findings.
• The pancreas transplant team will review the information to determine if a transplant evaluation is appropriate.
• If a transplant evaluation is appropriate, we will obtain insurance authorization and contact you to schedule the evaluation.

PAK transplant evaluation

At UPMC, we evaluate patients with severe complications related to diabetes to determine whether they are candidates for PAK transplant.

Does my care partner need to come to my PAK transplant evaluation?

We require all candidates to be accompanied by a primary care partner. The evaluation may be physically demanding, and it may be difficult for someone with severe complications from diabetes or who is recovering after a kidney transplant to get from one appointment/test or location without assistance.

It is also important for the primary care partner to attend the pre-transplant education class, meet with the transplant team members, and learn what to expect as a potential care partner after the transplant. Being a care partner is a big commitment, and the team will not recommend listing a candidate who lacks strong care partner support.

Your PAK transplant evaluation and care team

During your evaluation, you'll have various diagnostic tests and meet with a number of experts from the pancreas transplant team, including:

• Behavioral health nurses or psychiatrists — Assist you and your family in coping with the stresses associated with chronic disease and the transplant process. They will also assess any current psychiatric/mental health symptoms that are being treated or may need to be treated.
• Credit analysts — Review your insurance coverage and benefits information. They will help you to understand your insurance policy and will be your point of contact for insurance changes. They will also explain any parts of the transplant process that insurance does not cover and suggest options to assist with those costs.
• Endocrinologist — Examine you, perform a medical history and physical, and focus on the signs and symptoms of your diabetes. They may also review other options for managing your diabetes.
• Gastroenterologist — Diagnoses, treats, and manages pancreatic conditions.
• Nutritionists — Assess your nutritional status, dietary knowledge, and provide education and recommendations for your diet.
• Pancreas transplant surgeons — Assess your physical capability and risks for transplant. They will review your diabetes management and address all treatment options available to see if a pancreas transplant is the best option for you.
• Pharmacists — Meet with you to get a complete list of all the medicines and supplements you take, both prescription and over the counter, and ask you how you take your medicines.
• Research transplant coordinators — Transplant nurses who coordinate and oversee patients who participate in research studies and clinical trials.
• Social workers — Discuss your support team at home, your prescription insurance coverage, and other social aspects of the transplant process. You will also learn about fundraising options.
• Transplant nurse coordinator — Introduces you to the transplant process and reviews your evaluation schedule. The visit will include a preliminary health screening, a review of your medication, and an overview of the transplant process. Your transplant nurse coordinator is here to answer any questions you may have.

PAK transplant evaluation testing

Testing will include:

• Blood tests — To determine your blood type and check for signs of disease, infection, or other problems.
• Cardiac (heart) tests — To make sure your heart is healthy before surgery.
• Imaging tests — To assess your abdominal organs and look for signs of other health problems.

After your PAK transplant evaluation

A multidisciplinary team will review your case at a selection meeting and decide on approval of your PAK transplant. We will notify you of our decision shortly after the evaluation.

How much does a PAK transplant cost?

The cost of a PAK transplant can vary from patient to patient, depending on insurance coverage and other factors. If you wish to discuss the estimated cost, you will be given contact information for patient business services and a transplant credit analyst.

Pancreas transplant waiting list

If you're a candidate for a PAK transplant, we will place you on the United Network for Organ Sharing (UNOS) waiting list. Before being placed on the waiting list, your insurance company has to provide approval. You will be notified regarding the outcome by phone and mail.

If it is determined you are not a candidate for transplant at this time, you may be asked to return for additional testing to be cleared medically to be placed on the waiting list.

Your UPMC pancreas transplant team will continue to manage your diabetes with your local medical team while you wait for an organ.

While on the pancreas transplant waiting list

While on the pancreas transplant wait list, you need to live within a four-hour travel radius of UPMC in Pittsburgh so you can get to the hospital when we find a pancreas donor match. Pancreas transplants are done at UPMC Montefiore in Pittsburgh.

You will need to get tests periodically and be seen in the clinic at least every six months so the team can assess your readiness for transplant.

Most patients continue to see their primary endocrinologist for follow-up care during this waiting time. Your doctor will remain in contact with the transplant team at UPMC during this time, in addition to your regularly scheduled visits at UPMC.

If you don't live near Pittsburgh, please find a way to move closer. Family House is an affordable "home away from home" for pancreas transplant patients and their families. It is not a medical facility.

Learn more about traveling to Pittsburgh for transplant services.

How long will I need to wait for a PAK transplant?

The average wait time for a PAK transplant is two to three years. However, your wait time may vary depending on donor organ availability and other factors.

Your PAK transplant surgery

Your UPMC transplant coordinator will call you when a donor pancreas becomes available.

Before coming to the hospital

Before coming to UPMC for your PAK transplant:

• Do not eat or drink anything.
• Take an antimicrobial shower.
• Pack your cell phone and charger.
• Bring all your medications.

The surgeon will evaluate the donor pancreas to make sure it is the right size and type and that the antibody panel is a match.

When you arrive at the hospital

When you arrive at UPMC, we will admit you to a patient room where you will:

• Have a history and physical done.
• Have basic testing.
• See an anesthesiologist.
• Sign consent forms for the PAK transplant surgery.

We will prep you for PAK transplant surgery and give you general anesthesia.

How long does PAK transplant surgery take? 

PAK transplant surgery takes three to four hours. 

During your PAK transplant surgery

During a PAK transplant procedure, your surgeon will perform the following steps:

• Make an incision in your abdomen.
• Place the donor pancreas into your abdomen.
• Attach the donor pancreas to your blood vessels and other organs.
• Leave your existing pancreas in place to help with digestion.
• Close the incision.

Your new pancreas should start producing insulin within several hours of your transplant. Your coordinator or surgeon will be able to provide more details about your specific surgery.

Advanced techniques for complex PAK transplants

UPMC's team of pancreas transplant experts performs many complex pancreas transplant operations. We're equipped to handle the risks of surgery and address any complications. 

We also offer “bloodless” surgery for patients who meet strict health requirements. Bloodless medicine means we do not use banked blood products during the operation.

Your recovery after PAK transplant surgery

Your hospital stay

After PAK transplant surgery, we will take you to the transplant intensive care unit (ICU), where you will stay for several days.

We will give you pain medicine and antirejection drugs right away.

When your body detects your new pancreas, your immune system begins working to fight what it views as a threat. Antirejection drugs suppress your immune system's natural response to allow your body to accept the new pancreas.

When you're stronger, you will move to a patient room within the transplant unit. You can expect to stay in the hospital for six to eight days.

The pancreas transplant team will monitor your progress to make sure your body isn't rejecting the pancreas and that you aren't developing an infection or other problems.

Going home from the hospital

Before leaving the hospital, your pancreas transplant care team will review your:

• Activity restrictions.
• Blood test schedule.
• Diet and exercise guidelines.
• Follow-up visit schedule.
• Medication schedule.

Be sure you and your care partner fully understand your at-home care plan before you leave the hospital.

You'll also need to care for the incision site to prevent infection. Follow the directions your transplant nurse gave you before leaving the hospital.

Staying close to UPMC

The first few weeks after PAK transplant surgery are when you're at the highest risk for infection or rejection. That's why you will need to remain within one hour of UPMC for at least three to four weeks after discharge or as directed by your transplant team.

You must also always have your care partner with you during these first few weeks.

Family House offers an affordable "home away from home" near the hospital until you're ready to return home. It is not a medical facility.

Your care partner's role

An organ recipient needs a lot of help after transplant surgery. Being a care partner is a big responsibility. You may need more than one person to help you for the first few months after your PAK transplant.

A PAK transplant care partner will:

• Assist with daily activities within the home.
• Drive you to and from your follow-up appointments.
• Help you record all the information that the transplant team requests.
• Help you stick to your post-transplant treatment plan.
• Keep family and friends informed of your needs and wishes.
• Look for signs of unusual behavior and contact your UPMC transplant coordinator if anything seems wrong.
• Make sure you take medications in the right doses at the correct times.
• Provide support, encouragement, and entertainment.
• Run errands, fill prescriptions, and do chores around the house.
• Shop for food and prepare meals.

Your follow-up appointments

At first, you will have frequent follow-up visits so the pancreas transplant team can make sure you're healing properly.

After that, you will return to UPMC's post-transplant clinic at least every few months for the first year.

Our team at UPMC will take care of you for at least the first two years following transplantation, and ideally for life. In some special circumstances, you may find a local transplant center that can help take care of you.

Antirejection medications

You'll continue to take the antirejection drugs you received at the hospital for the rest of your life. Your doctor will continuously monitor how you respond and make adjustments as needed to find the right treatment.

The antirejection drugs make you more susceptible to developing infections.

After PAK transplant surgery, limit your exposure to people with illnesses or places where people are likely to be spreading germs.

Call us if you have any signs of infection, which include:

• Chills.
• Fever over 100.4°.
• Swelling, redness, or fluid draining from the incision site.

Life after PAK transplant

Most people who receive a PAK transplant at UPMC have good results and can gradually return to their normal routines within six to eight weeks. You will no longer need to take insulin to manage your diabetes.

To make the most of your new pancreas, it's important to follow your treatment plan and maintain a healthy lifestyle.

Be sure to:

• Take all medications as prescribed — If you have any questions, call our office.
• Stick with your personalized nutrition plan — Follow the recommendations your nutritionist created for you, based on your medications.
• Avoid all nicotine products — This includes cigarettes, cigars, smokeless tobacco, e-cigarettes, nicotine patches, gum, or any other form of pharmaceutical nicotine. You should also avoid all forms of vaping, even if products claim to be nicotine-free.
• Exercise regularly — Begin with short walks, as you're able.

Remember that the UPMC pancreas transplant team is here for you for the rest of your life.

When to call your doctor about complications

You should let your surgeon know if you have:

• A fever of more than 100.0°F.
• Difficulty breathing.
• Numbness, tingling, pain, swelling, or weakness in your arms or legs.
• Pain, redness, bleeding, drainage, or increased swelling at your surgical site.
• Severe pain that does not respond to medication.

What’s the survival rate after a pancreas transplant?

Survival rates for PAK transplant vary. However, if your PAK transplant is not successful, you can start taking insulin again and talk to your transplant team about having a second transplant.

Why Choose UPMC for PAK Transplant?

When you choose UPMC for PAK transplant care, you will receive:

• Access to experienced, board-certified specialists — As one of the nation’s most active and experienced transplant programs, UPMC has vast experience in kidney, pancreas, PAK, and combined kidney-pancreas transplants. 
• Outstanding transplant results — UPMC is among the leading centers in the United States for pancreas transplant volume while maintaining outcomes comparable to national averages.
• Expert care for complex cases — Our talented team of pancreas transplant surgeons continues to gain vast clinical skills and expertise in the field, allowing them to accept many high-risk patients that other transplant centers may decline. 

By UPMC Editorial Staff. Last reviewed on 2025-12-09.