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Pre-transplant Evaluation

Patients must have diabetes to be candidates for pancreatic transplant, and they almost always have kidney failure as well – receiving a pancreas (and kidney) as part of organ transplantation to treat both conditions.   (Patients who have kidneys that function consistently at 20 percent or less of normal, or who are on maintenance dialysis, are candidates for kidney transplant evaluation.)

Once the Lourdes transplant team confirms these basic criteria and verifies insurance coverage, the staff can schedule patients for a transplant evaluation, which the team conducts at its pre-transplant clinic located at:

63 Kresson Road
Suite 106
Cherry Hill, NJ 08034.

Appointments are available in the morning and afternoon and can last approximately three to four hours.   At the evaluation, patients meet individually with a nurse coordinator, dietitian, social worker, and either a transplant surgeon or transplant nephrologist.   The team will perform an assessment (including physical examination, history, current medications), provide individualized education regarding pancreas (and kidney) transplant and guide the patient through the process of potential listing on the national waitlist.

Recognizing that this process can be overwhelming for some, the team encourages the patient to bring his or her loved ones or support person (as well as any potential kidney donors) to the visit.

Patients will also have a variety of blood tests drawn the day of evaluation to confirm blood type and test for various viruses and diseases.   The staff will assess the patient overall health in preparation for kidney transplant surgery.

The team will formulate a plan for medical testing, consultations and follow-up of any concerns discovered during the evaluation.   In many instances, patients may have already had some of these tests and consultations completed due to previous hospitalizations or health concerns.   In that case, the team endeavors to obtain copies of those records and review them.

Patients already listed at another transplant center must still undergo evaluation by the Lourdes kidney/pancreas transplant team, even as records are obtained from the other transplant centers.   Please see below a list of the common testing ordered as part of the transplant evaluation:

  • All female candidates will have a gynecological exam and PAP smear.   Follow up GYN exams and pap smears will be done at intervals as clinically indicated or according to recommendations by gynecologists or preventive care guidelines based on patients’ age and risk factors.
  • All female candidates over age 40 must have had a mammogram within one year or undergo one.
  • The 12-lead EKG helps to check cardiac status.
  • An echocardiogram is performed as close to the end of dialysis treatment as possible.
  • Patients over age 50 or any age with family history of colorectal cancer must have results current for colonoscopy according to guidelines or undergo one.
  • A chest X-ray helps to confirm lung status.
  • All male candidates over age 40 must have a recent PSA result or have this blood test done.

Additional tests for cardiology assessment may include a stress test and cardiac catheterization based upon the assessment of patient’s comorbidities.   Additional testing for transplantation may be required based on the initial evaluation, history and physical exam or results of testing.

The new allocation system for pancreas broadens the criteria used currently by centers, allowing for some type 2 diabetics who would benefit from pancreas transplant and increasing usage of all potential pancreas donor organs.

Simultaneous pancreas-kidney transplant candidates must meet the current kidney failure criteria (used for kidney transplant listing), be on insulin therapy, and have one of the following:    

  • C-peptide level of 2.0 or less
  • C-peptide level of greater than 2.0 and a BMI of less than 28.

Pancreas-after-kidney or pancreas-alone candidates must have one of the following:

  • diabetes that requires insulin therapy
  • diabetes complications that cannot be well managed with conventional therapy
  • severe pancreatic exocrine insufficiency.

 

Learn more about the program and its criteria, and recent organ allocation changes.

Learn more about the program and its criteria, and recent organ allocation changes.

While many factors determine who is better suited for this operation, the best candidates for pancreas or combined kidney-pancreas transplant are patients with:

  • adequate heart, lung and liver function
  • a reasonable body mass index not indicative of severe obesity
  • absence of active infections, malignancies or other major conditions
  • ability to undergo major surgery and tolerate post-transplant medications
  • a strong record of self-care and compliance with their medical regimen, as well as an adequate circle of support and system of and services and care
  • the medical coverage necessary to pay for a life-long course of immunosuppressive drugs needed after surgery, or supplemental sources of coverage for these medications
  • and absence of drug and alcohol use.

 

Note: Exclusion CriteriaPancreas Transplant Absolute Exclusion Criteria

Patients with these conditions are not considered candidates for pancreas transplant at Lourdes

  • HIV (Lourdes will refer to program that will accept)
  • Type I diabetes with normal renal function without evidence of a brittle course or evidence of nephropathy
  • current / metastatic malignancy
  • cardiac status that is:obesity BMI greater than 35
    • inoperable multi-vessel coronary artery disease
    • heart disease that is not responsive to treatment (heart failure class 4)
    • cardiac left ventricular ejection fraction of less than 30 percent (a measure of heart capacity and output)
  • known active substance abuse
  • significant uncontrolled psychiatric illness likely to impair consent and adherence
  • recalcitrant, chronic non-adherence to medical care
  • severe pulmonary hypertension

Pancreas Transplant Relative Exclusion Criteria

Patients with these conditions will be disqualified for pancreas transplant at Lourdes unless there are special circumstances.   Patients may be referred with these conditions and will be evaluated on an individual basis.

  •  active infection
  • active immunologic disease
  • cardiac left ventricular ejection fraction of less than 40 percent (a measure of heart capacity and output)
  • age greater than 60
  • no insurance (for coverage of immunosuppressant drugs)
  • current active smoking
  • persistently low blood pressure, especially requiring Midodrine
  • moderate pulmonary hypertension

If current trends continue, the number of people nationwide who are in kidney failure and on dialysis will soon reach one-half million – the primary cause being high blood pressure and/or diabetes.

 

 

 

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