Simultaneous Pancreas-Kidney (SPK) Transplant

Simultaneous pancreas-kidney (SPK) transplants can help people with kidney failure caused by type 1 and type 2 diabetes who need both a new kidney and a new pancreas. Surgeons transplant both the kidney and pancreas during one surgery, with both organs typically coming from the same deceased donor. In some cases, surgeons may use a kidney from a living donor and a pancreas from a deceased donor.

UPMC is among the world’s most experienced transplant programs and offers advanced care for people who need a pancreas 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 A Simultaneous Pancreas-Kidney (SPK) Transplant?

Simultaneous pancreas-kidney (SPK) transplants help people with kidney failure caused by type 1 and type 2 diabetes who need both a new kidney and pancreas.

Surgeons transplant both the kidney and pancreas during one surgery, with both organs typically coming from the same deceased donor. In some cases, surgeons may use a kidney from a living donor and a pancreas from a deceased donor.

Conditions we treat with SPK

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

Why Would I Need An SPK Transplant?

If you have kidney failure caused by type 1 diabetes, you may need an SPK transplant. You may also need an SPK transplant if you have kidney failure caused by type 2 diabetes. 

Who’s a candidate for SPK transplant?

You may be a candidate for SPK transplant if you are an adult who is diagnosed with type 1 diabetes and kidney failure.

Who may not be a candidate for SPK transplant?

You may not be a candidate for SPK transplant if you have:

• Active infections.
• Cancer.
• Inability to follow your pre- and post-transplant treatment plan.
• Severe heart disease.
• A severe, untreated psychiatric disorder.
• Active substance abuse, such as alcohol or drug use.

Alternatives to SPK transplant

• Pancreas-after-kidney (PAK) transplant.
• Pancreas transplant alone (PTA).

What Are the Risks and Complications of SPK Transplant?

Risks associated with SPK transplant may include:

• Bleeding.
• Complications related to immunosuppressive medication.
• Infection.
• Organ rejection.
• Side effects from anti-rejection medications.

What Should I Expect From SPK Transplant?

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

SPK transplant patient information review

After the UPMC 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-kidney 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.

SPK transplant evaluation

At UPMC, we evaluate patients with kidney failure and other severe complications related to diabetes to determine whether they are candidates for SPK transplant.

Does my care partner need to come to my SPK 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 kidney failure and severe complications from diabetes 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 significant commitment, and the team will not recommend listing if the candidate does not have strong care partner support.

Your SPK transplant evaluation and care team

During your evaluation, you'll have various diagnostic tests and meet with a number of experts from the SPK 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.
• Nephrologist — A kidney specialist who diagnoses, treats, and manages kidney disease.
• Nutritionists — Assess your nutritional status, dietary knowledge, and provide education and recommendations for your diet.
• Pharmacists — Will 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 — Will 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.
• Transplant surgeons — Assess your physical capability and risks for transplant. They will review your kidney disease and diabetes management and address all treatment options available to see if SPK transplant is the best option for you.

SPK transplant evaluation testing

Testing will include:

• Blood tests — To determine your blood type, level of kidney function, 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 SPK transplant evaluation

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

How much does an SPK transplant cost?

The cost of an SPK 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.

SPK transplant waiting list

If you're a candidate for an SPK 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 SPK transplant team will continue to manage your kidney failure and diabetes with your local medical team while you wait for your new organs.

While on the SPK transplant waiting list

While on the SPK transplant wait list, you need to live within a four-hour travel radius of UPMC so you can get to the hospital when we find an organ donor match. 

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 and nephrologist 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 SPK 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 an SPK transplant?

The average wait time for an SPK is one to two years. However, your wait time may vary depending on donor organ availability and other factors.

Your SPK transplant surgery

Your UPMC transplant coordinator will call you when donor organs become available.

Before coming to the hospital

Before coming to UPMC for your SPK 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 and kidney to make sure they are 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 SPK transplant surgery.

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

How long does SPK transplant surgery take?

SPK transplant takes six to eight hours.

During your SPK transplant surgery

During an SPK 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.
• Place the donor kidney in your abdomen.
• Leave your existing kidney in place.
• Close the incision.

Your new pancreas should start producing insulin within several hours of your transplant. Your kidney may start working immediately, or within several days or weeks. Your coordinator or surgeon will be able to provide more details about your specific surgery.

Advanced techniques for complex SPK transplants

UPMC's team of transplant experts performs many complex SPK 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 SPK transplant surgery

Your hospital stay

After SPK 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 organs, 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 organs.

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

Going home from the hospital

Before leaving the hospital, your SPK 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 SPK transplant surgery are when you have the highest risk for infection or rejection. That's why you will need to remain within one hour of UPMC for at least 3-4 weeks after discharge or as directed by your transplant team.

You must also have a care partner with you at all times during these first few weeks.

Family House offers a "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 SPK transplant.

An SPK 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 right 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 SPK 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 be able to 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 SPK 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 SPK transplant

Most people who receive an SPK 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 organs, 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 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 SPK transplant?

Survival rates for SPK transplant vary. Nationally, one-year survival rates in adults are more than 97%, and five-year survival rates are more than 92%.

Why Choose UPMC for SPK Transplant?

 When you choose UPMC for SPK 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, and combined kidney-pancreas transplants. 
• Outstanding transplant results — UPMC is among the leading centers in the United States for kidney and pancreas transplant volume while maintaining outcomes comparable to national averages.
• Expert care for complex cases — Our talented team of kidney and pancreas transplant surgeons accepts many high-risk patients that other transplant centers may decline. We also use advanced surgical techniques to enhance transplant outcomes.

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