Pancreatic transplantation referrals

 

Referral contacts

Mr Martin Drage, lead clinician for pancreatic transplantation
Tel: 020 7188 8476 
Email: martindrage@nhs.net

  • Selection criteria

    Selection criteria for simultaneous pancreas kidney (SPK) transplantation

    • Presence of Insulin-dependent Diabetes Mellitus (DM) & Chronic Renal Failure already on dialysis or anticipated dialysis within 6 months (eGFR < 30 ml/min/1.73 m2)
    • Recipient Age < 60 (the vast majority are < 55)
    • Body Mass Index (BMI) < 30 kg/m2
    • Adequate cardiovascular reserve - Assessed by Echocardiogram & Exercise Tolerance test (OR Thallium myocardial perfusion scan OR Dobutamine Stress Echo)
    • Adequate respiratory reserve – Lung Function tests if symptomatic (or history of asthma or COPD)

    N.B: Type II DM patients may also be eligible if BMI is close to or < 25, who are also insulin requiring and fulfil the above criteria

    Selection Criteria for Pancreas Transplant Alone (PTA) Transplantation

    • Presence of Insulin-dependent Type I Diabetes Mellitus
    • Life-threatening complications: hypoglycaemic unawareness, "brittle diabetes" with frequent or severe episodes of hypoglycaemia
    • eGFR > 70 ml/min/1.73 m2
    • A joint assessment with the Diabetes Team at King's College Hospital will be undertaken

    Selection Criteria for Pancreas After Kidney (PAK) Transplantation

    • Patients with stable function of a previous renal allograft (eGFR > 40 ml/min/1.73 m2) who meet criteria for SPK

  • Contraindications to transplant

    Absolute contraindications

    • Insufficient Cardiovascular reserve: inability to climb a flight of stairs without stopping, MI in the last 6 months, known uncorrectable significant coronary artery disease
    • Poor compliance (e.g. ongoing substance abuse (drug or alcohol) or psychiatric illness)
    • Immunosuppression likely to lead to life-threatening complications (e.g. active peptic ulcer disease, e.g. active sepsis (dental caries / diabetic foot disease with ulceration / osteomyelitis )
    • "Incurable" malignancy (excluding localised skin malignancy)
    • BMI > 35 kg/m2

    Relative contraindications

    • Extensive Peripheral Arterial Disease
    • CVA with functional Impairment
    • Significant history of non-compliance or ETOH/Drug abuse
    • Hepatitis B, Hepatitis C, (HIV)
    • BMI > 30

  • Investigations to be completed before referral

    Results should accompany the referral letter.

    FBC

    • Lupus Anticoagulant and Anti-Cardiolipin Antibody screen
    • (Full thrombophilia screen only in case of a first-degree relative with or a PMH of: SLE or DVT/arterial thrombosis, or PMH of fistula thrombosis or recurrent miscarriage)

    Blood Group

    • U&E's, eGFR, Ca & P, LFT's, Glycosylated haemoglobin (HbA1c)
    • Routine Transplant Assessment Infection Screen (e.g. Virology (HbsAg & anti-HBc, HCV Ab, CMV, EBV, HIV, Varicella-Zoster), MRSA screen, urinalysis with MC&S)

    CXR report, copy of 12-Lead ECG

    • Iliac Artery Duplex: (For age>50, BMI>30, abnormal ECG (other than LVH), history of IHD / vascular disease, dialysis >3yrs or previous transplant)
    • Iliac Vein Duplex: (if previous DVT, groin line or previous transplant nephrectomy)
    • Echocardiogram in all (except if a cardiologist leads the work-up)
    • Myocardial Perfusion scan OR Dobutamine Stress Test (If age >50, Diabetes Mellitus, history of IHD / any vascular disease, abnormal resting ECG (other than LVH with ST/T wave changes), dialysis > 3 yrs or previous renal transplant)
    • Ultrasound report of native kidneys (or an old non-functioning transplant)

Referring centres may find the work-up sheet (PDF 75Kb), which we use at Guy's, useful as a checklist.