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Pancreatic transplantation referrals

 

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

  • 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

  • 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

  • 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.