Coronavirus: pancreatic transplant update
In response to the coronavirus (COVID-19) outbreak, please read our advice and information before sending any referrals.
Referral contacts
Mr Chris Callaghan, lead clinician for pancreatic transplantation
Tel: 020 7188 1543
Email: chriscallaghan@nhs.net or pancreastransplant@gstt.nhs.uk
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Recipient selection criteria
Selection criteria for simultaneous pancreas kidney (SPK) transplantation
- Presence of insulin-dependent diabetes mellitus (DM) and chronic renal failure already on dialysis or anticipated dialysis within six months (estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m2)
- Age < 65 years (most patients are < 55 years)
- Body mass index (BMI) < 32 kg/m2 (most patients have BMI < 30 kg/m2)
- Adequate cardiovascular reserve - assessed by echocardiogram and exercise tolerance test (or nuclear medicine myocardial perfusion scan or dobutamine stress echocardiogram)
- Adequate respiratory reserve – lung function tests if symptomatic (or history of asthma or COPD)
N.B: Patients with type II DM may also be eligible if BMI is < 30 kg/m2, and they also need insulin and meet 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 > 40 ml/min/1.73 m2
- A joint assessment with the diabetes team at King's College Hospital will be undertaken
- BMI, and heart and lung reserve as per criteria for an SPK transplant
Selection criteria for Pancreas After Kidney (PAK) Transplantation
- Presence of insulin-dependent diabetes mellitus
- Patients with stable function of a previous renal kidney transplant (eGFR > 40 ml/min/1.73 m2)
- BMI, and heart and lung reserve as per criteria for an SPK transplant
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Contraindications to transplant
Absolute contraindications
- Insufficient cardiovascular reserve: inability to climb a flight of stairs without stopping, heart attack in the last six months, known uncorrectable significant coronary artery disease, poor heart function on testing
- Poor compliance (e.g. ongoing substance abuse (drug or alcohol) or major 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
- Stroke with major functional impairment
- Significant history of non-compliance or alcohol/drug abuse
- Untreated hepatitis B, hepatitis C or HIV
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Investigations to be completed before referral
Results should accompany the referral letter.
- Urea and electrolytes (U&Es), eGFR, calcium and phosphate, liver function tests, glycosylated haemoglobin (HbA1c)
- Full blood count
- Blood group
- Routine transplant assessment infection screen (e.g. HbsAg & anti-HBc, HCV Ab, CMV, HTLV, toxoplasma serology, treponema serology, EBV, HIV, VZV), MRSA screen, urinalysis with MC&S)
- CXR and 12-lead ECG
- Iliac artery and vein ultrasound
- Echocardiogram
- Myocardial perfusion scan or dobutamine stress echocardiogram
- Ultrasound report of native kidneys (or an old non-functioning transplant)
Referring centres should contact the pancreas transplant coordinator or the lead pancreas transplant surgeon for an up-to-date copy of our recipient work-up guidance document.