Pancreas Transplant Program

A patient does not have to be on dialysis to qualify for kidney-pancreas transplant evaluation. We prefer to educate and evaluate patients early in the course of their disease. To be considered, candidates must have a full understanding of the kidney-pancreas transplant procedure, its limitations, and long-term follow-up requirements. They must also have a strong social support network, especially family, be free from active drug, nicotine or alcohol abuse, have a BMI of less than 30, and be free from medical conditions that may affect immediate or long-term survival.

In patients who have both type 1 diabetes and kidney failure, a transplant that includes both a healthy kidney and a healthy pancreas may be recommended. One key reason is that the newly transplanted pancreas will produce proper amounts of insulin to maintain blood sugar at normal levels. Since elevated blood sugar is associated with kidney damage, returning blood sugar levels to normal may protect the new kidney from diabetic damage. A kidney-pancreas transplant may also help prevent other complications of diabetes from becoming worse. Most patients with diabetes are able to stop taking insulin injections following a kidney-pancreas transplant.

• Insulin-dependent diabetes regardless of type, typically requiring less than 75 units of insulin per day
• Body mass index of 30 kg/m2 or less
• Stage 4 (GFR <30 mL/min) or greater chronic renal failure
• Absence of a systemic illness or medical condition that significantly decreases estimated short- or long-term survival; examples include severe cardiovascular or peripheral vascular disease and disseminated malignancy
• Ability to be compliant with a complicated long- term medical treatment regimen; important factors may include a strong social/family support system and freedom from active drug or alcohol abuse
• An adequate financial plan to obtain the required long-term immunosuppressive medications needed post-transplant

After we receive a referral, we will fax a confirmation letter to the referring provider which includes the patient's education class appointment date. All patients must take a transplant education class to continue in the evaluation process. A letter will be mailed to the patient informing them of the date they are scheduled for class.

If a patient does not attend a scheduled education class, we will attempt to contact the patient three times, using all phone numbers provided. If contact attempts are unsuccessful, a letter will be sent to the patient and referring provider indicating that we will not pursue our efforts to evaluate the patient for transplant.

Patients who attend the educational class have two options:

• Move forward with evaluation
• Decline to move forward with evaluation. A letter will then be sent to the referring physician and the patient stating that we will not proceed with the transplant evaluation.

If the patient has no medical contraindications after review by the transplant physician, the patient will be scheduled for a two-day evaluation process.

Kidney-Pancreas Transplant Evaluation: Day One

Day one of the kidney-pancreas transplant evaluation will consist of several tests and appointments. Patients will be scheduled for an EKG, a chest X-ray, and consultations with a physician, a social worker, a financial coordinator, a pre-transplant coordinator, and a dietitian.

Findings from day one of the evaluation will be communicated by to the referring physician by phone, and the appropriate reports will be faxed.

Kidney-Pancreas Transplant Evaluation: Day Two

Day two of the evaluation will take place three weeks after the day one appointment.

The patient will have consultations with the following specialists:

• Transplant surgeon
• Transplant nephrologist
• Cardiologist (if patient has a history of coronary artery disease requiring intervention such as CABG or angioplasty/stent placement or history of severe cardiomyopathy)
• Mental health specialist (if patient has a history of depression, bipolar disorder, schizophrenia, eating disorder, noncompliance, significant substance abuse, or any other mental illness)
• Hepatologist (if patient has a history of hepatitis B or C or other liver disease)
• Hematologist (if patient has a history of sickle cell anemia or other hematologic disease)
• Pulmonologist (if patient has a history of COPD or sleep apnea)

Additional tests include:

• Colonoscopy (required in all patients over age 50 who have not had a colonoscopy in the last 10 years)
• Pap smear and gynecological exam (required in all women and should be performed within one year of the transplant evaluation and maintained yearly)
• Mammogram (required in all women over age 35 and should be performed within one year of the transplant evaluation and maintained yearly)
• MRI or CT of the abdomen and pelvis (required in all patients who do not have updated abdominal imaging)
• MRA or CTA of the abdomen and pelvis (required in all patients with diabetes and all patients with a history of peripheral vascular disease)
• Carotid duplex (required in all diabetic patients and in other patients as indicated by medical history or physical examination findings)
• Cardiac testing (may consist of an echocardiogram, a dobutamine stress test or a thallium stress test)

A letter will be sent to the referring physician after day two of the evaluation, updating the patient's status.

Patient cases will be presented at the weekly Kidney-Pancreas Transplant Selection Committee meeting one week after the Day Two Evaluation visit. The history/physical, chest X-ray, EKG, labs, diagnostic test results and consultation reports will be presented. The committee decision will be one of four possible outcomes:

1. Medically Approved (pending financial clearance)

Once financial approval is given, the patient will be placed on the waiting list.

2. On Hold Green

This patient has minimal requirements to complete prior to approval for listing. Committee members will discuss the patient's case and order any further consults/testing that are required for this patient prior to approval for transplantation.

3. On Hold Yellow

This patient has significant requirements to complete prior to approval for listing. Committee members will discuss the patient's case and order any further consults/testing that are required for this patient prior to approval for transplantation.

4. Denied

This patient is referred back to referring physician for alternative treatment options.

Patients will be notified of the committee decision via telephone by the pre-transplant coordinator within three business days of the committee meeting. Patients and referring physicians will receive a letter and copy of the Transplant Evaluation Summary. This summary indicates the patient's current transplant status and lists all items that must be resolved in the next 90 days in order for the patient to be approved for transplantation and placed on the waiting list. The referring physician will also receive copies of the laboratory results, diagnostic study reports and consultation reports.

Pre-transplant coordinators will work with patients to complete outstanding requirements listed on the Transplant Evaluation Summary within 90 days of the transplant evaluation. If the listed items are not completed within 90 days, the patient's evaluation status will be changed to inactive.

To re-enter our program at a future date the patient must be re-referred. Should the referring physician wish for the Emory Kidney-Pancreas Transplant Program to reconsider this decision, s/he may contact the transplant office at 855-366-7989.