again ,” she recalled . “ I was looking forward to seeing my lab results at my next doctor ’ s appointment .”
But those lab results showed that her kidney function had plummeted to the point where she met the criteria to be evaluated for a transplant . “ I was devastated ,” Nichols said . “ For me , that was my absolute worst-case scenario .”
Her wait to meet with the UAB Comprehensive Transplant Institute ( CTI ) care team felt like an eternity , but her appointment transformed her perspective . “ They were so positive , and they recommended that my best option was to get a kidney and a pancreas ,” Nichols said . A successful double transplant would heal her acute kidney failure and her diabetes . “ They were the light at the end of the tunnel ,” she said . “ After that appointment , I felt confident and at peace .”
A rare double transplant Douglas Anderson , M . D ., a surgeon with the UAB CTI , said it ’ s relatively rare to transplant both a pancreas and a kidney . “ The busiest programs perform several hundred kidney transplants each year , but do only 30-40 combined transplants ,” he said . “ We perform fewer than a dozen pancreas transplants each year .”
There are so few pancreas recipients because relatively few patients can reap significant benefits from the surgery . “ Although diabetes is common , a new pancreas won ’ t address insulin resistance or help those who need 90 or 100 units of insulin each day ,” Dr . Anderson said . “ Well-managed insulin therapy has fewer risks than potential complications from post-transplant immune suppression .”
People like Nichols are an exception . Patients with type 1 diabetes who are getting a kidney transplant are already going to be on immunosuppressant medications , and a new pancreas allows these patients to stop insulin therapy , so the benefits outweigh the risks . “ Ms . Nichols ’ pancreas didn ’ t make insulin , and her new pancreas restored insulin production ,” Dr . Anderson said . “ And because diabetes affects kidney function , a new pancreas meant that the transplanted kidney would do better in the long run .”
The clock starts Nichols was evaluated as a transplant candidate in December 2021 , completed her testing in January 2022 , and received a letter saying she was on the active waitlist for both organs in February 2022 . “ At that point , it finally felt real ,” she said .
Nichols was notified four times that a new kidney and pancreas might be available for her . “ In June 2022 , I was notified that I was a backup recipient ,” she recalled . “ I got another call in August 2022 , but I had COVID-19 at the time and was unable to proceed . Then , on January 21 , 2023 , I had an 11-hour standby as a backup recipient .” At the end of January , Nichols received the call that would change her life . “ It was another backup call , but this time it felt different ,” she said . “ Within 30 minutes I was called to UAB .”
Dr . Anderson said multiple calls to a potential kidney-pancreas recipient are common . “ The pancreas is a challenging organ to work with , in that we don ’ t know if it ’ s usable until it ’ s recovered from the donor ,” he said . “ It can have edema , firmness , or fibrosis – things you can ’ t always tell ahead of time .” Because the pancreas is susceptible to forming blood clots following transplant , “ we want an organ with the best vessels to have the greatest chance for success ,” he said .
Today , Nichols counsels other recipients on the waitlist not to lose faith . “ When it seems like you ’ re in a season of waiting , it ’ s important to remember that you ’ re in the hands of a team you trust ,” she said . “ You don ’ t want it to happen fast – you want the perfect organ match for you .”
Celebrating the gift Nichols came home from UAB Hospital in February 2023 , exactly one year to the day after being placed on the active waitlist . “ My life totally transformed in a year ,” she said . Now , after 25 years of having diabetes , she no longer needs insulin therapy .
Nichols delights in watching four-year-old Grant grow , and she cherishes creating memories with him and Blake . But she knows that her life came at a cost for another . “ We celebrate my donor ’ s life , celebrate each milestone in their memory , and keep their family in our daily prayers ,” she said . “ I honor my donor by waking up every day with a heart of gratitude for their selfless gift .”
ORGANS – PANCREAS uabmedicine . org / refertransplant 17