What to Expect
Although recovery times vary from patient to patient, and complications are unpredictable, you can anticipate being in the post anesthesia care unit (PACU) for 4 to 12 hours. Once you leave the PACU, or the intensive care unit, you will move to Farr 10, our inpatient transplant unit. You will learn how to care for yourself here so you will feel confident and comfortable when you are ready to go home.
Out of Bed
You will be out of bed and walking with assistance the day of, or the day after, your operation. We will give you fluids to drink 24 to 48 hours after the surgery, and you can begin to eat solid foods when you can tolerate them. Your new pancreas should start to make insulin immediately following the transplant. Initially you may need to take low levels of insulin so as not to stress the newly transplanted pancreas. But when you are ready to leave the hospital, you will no longer need to take insulin injections. You will, however, need to monitor blood sugars closely twice a day for the first month, then once a day for the next couple of months. If your blood sugars seem stable, you will be able to stop checking so frequently.
If you have had a simultaneous pancreas and kidney transplant, you may need dialysis if your new kidney does not produce urine right away. While this can be disappointing, it does not mean the kidney will never work properly. Barring any complications, you could go home from the hospital within 4 to 7 days.
While in the hospital, staff will:
- Order blood tests to be drawn at least once a day
- Take your temperature and blood pressure several times a day
- Weigh you every day
- Check your incision several times a day and change the dressing as needed
- Empty the catheter and drain bags
- Adjust your intravenous lines
- Help you learn about your medications; symptoms to watch for at home; specific diet requirements; and any needed post-op care
- Help you prepare to go home or to another facility in numerous ways such as making sure you can bathe and walk by yourself, take your medications properly, change your dressing, and empty any drains
More about Your Daily Care
While you are on the transplant unit, you will continue coughing and deep breathing exercises to keep your lungs clear of fluid. Your nurses will also encourage you to get out of bed and walk around your room and down the hall at least three times a day. Walking increases your blood circulation, helps relieve gas pains, and helps maintain your muscle tone.
Some people have trouble sleeping while in the hospital, and some people experience strange dreams that seem very real. Many transplant recipients also report memory problems after the surgery. These problems are temporary. Talk with your doctor if this persists or troubles you. Your appetite and energy level will not be the same as it was before the surgery. In general these will return to baseline within a few weeks of the transplant.
For a detailed, day-to-day description of your care on Farr 10, click here to download "A Guide to Your Daily Care."
Our Nursing Staff
Our nurses at BIDMC are the heart and soul of patient care delivery. Nursing's dedication to compassionate care is one of the medical center's guiding strengths. Patients, peers and colleagues recognize our nurses for their valued expertise and proficiency.
Patient satisfaction surveys applaud nurses throughout the medical center, including those who are part of our Transplant Center, for their exemplary efforts in meeting patient needs.
Transplant Center nurse coordinators and nurses on staff in PACU and Farr 10 have extensive experience with the post-transplant patient. They are often the best resource for patients and families when there are questions regarding your care.
The transplant nurse coordinator will follow you during your evaluation and after transplant to ensure continuity of care.
Physical Therapy
A physical therapist will visit you post-transplant, and may have seen you pre-transplant. Our therapists will help you regain your strength and teach you how to move about more comfortably.
Case Management Services
Case managers constantly monitor your progress. They help develop a discharge plan, including decisions about whether you should move to a facility for rehabilitation or arrange for homecare services. They work with you and your family to set up these and any additional services you might need.
Social Work Services
A social worker will also see you, and perhaps your family, to help with coping strategies, home arrangements, and any other issues surrounding your transplant.
Learning to Care for Yourself
You will have many things to remember when you leave the hospital. Taking an active role in your self-care and developing a daily routine while you are in the hospital will help you better care for yourself after you go home.
One of the most important things you will learn on Farr 10, under the guidance of our experienced nurses, doctors and other staff members, is how to take care of yourself safely.
Your role as a member and a partner of the transplant team becomes more important than ever at this point because your new pancreas will need a lot of care, attention, and monitoring to do its job. Having a new pancreas is a life-long commitment!
Learning about Your Meds
Your transplant team will decide what medications are right for you. You will have to take immunosuppressive medication to prevent the rejection of the transplanted pancreas (and kidney if you have had a combined transplant). You will take these medications for as long as you have a functioning organ transplant.
We are among a handful of centers to offer pancreas transplant patients immunosuppressive protocols to minimize the effects of chronic steroid use. Typically immunosuppressive drugs contain steroids. Steroids may elevate blood sugar levels, which can stress the newly transplanted pancreas and have many other undesirable side effects.
In addition to the immunosuppressants, you will also have to take medications to prevent infection, although you will not have to take these medications for long. You may also need medications after your transplant to help control your blood pressure and cholesterol.
The team will adjust your meds in the hospital and will continue to monitor their effectiveness after discharge. We will teach you the names and basic effects of each drug you need to take. Remember, taking your medications is your responsibility. If you are unable to take your medications at home for some reason, you must call the Transplant Center.
Transplant Medication
These medications suppress the immune system enough to keep the transplanted pancreas healthy. The three main categories of medication include induction immunosuppression, maintenance immunosuppression and rescue therapy for the treatment of rejection:
- Induction immunosuppression is the initial high dose medication, both intravenous and oral, that you take in the first 1 to 2 weeks after your transplant.
- Maintenance immunosuppressants are also started while you are in the hospital. You will continue on these medications in order to prevent your body from rejecting the pancreas transplant over time.
- Rescue therapy for the treatment of rejection is typically given as an intravenous medication while in the hospital.
For more information about transplant medication, visit the American Society of Transplantation (AST) Web site: www.myast.org, under the patient education section.