Kidney/Pancreas Transplant Program
Indications and Contraindictions - Pancreas
Indications for Pancreas Transplantation
(Solitary pancreas transplant, pancreas transplant alone, pancreas after
Patients with insulin dependent (type 1, juvenile diabetes) diabetes may be
candidates for pancreas transplantation. Patients who are candidates for solitary
pancreas transplantation are individuals with secondary diabetic complications
that are progressive despite the best medical management.
These secondary complications include diabetic neuropathy, retinopathy, nephropathy,
gastroparesis, and autonomic neuropathy or extremely brittle diabetes. In some
cases these patients will have received a prior kidney transplant, usually from
a living donor (living donor kidney transplant alone - LDKTA).
Documentation of progressive disease can come from a board-certified endocrinologist
with whom the patient has a long-standing relationship. Objective testing from
a retinal examination by an ophthalmologist (retinopathy), electromyogram and
nerve conduction testing (neuropathy), gastric emptying studies (gastroparesis)
and cardiorespiratory reflux testing (autonomic neuropathy) may be valuable
in uncertain cases.
For patients for whom the indication is brittle diabetes, there should be
evidence of frequent hypoglycemic events despite an attempt at optimal
management by an endocrinologist. Patients with brittle diabetes as the primary
indication should have evidence of impairment of employability,
hypoglycemic-induced accidents involving themselves or small children in their
care. Usually there is evidence of frequent emergency care for hypoglycemia or
Contraindications for Pancreas Transplantation
There are certain absolute contraindications to pancreas transplantation:
- HIV infection
- Disseminated or untreated cancer
- Severe psychiatric disease
- Unresolvable psychosocial problems
- Persistent substance abuse
- Severe mental retardation
- Un-reconstructable coronary artery disease or refractory congestive heart failure
Relative Contraindications to Pancreas Transplantation:
- Cardiovascular disease. All Type 1 diabetic patients require dobutamine
stress echocardiography or exercise or pharmacologic stress scintigraphy prior
to consideration. Candidates with positive stress testing or with a history
of congestive heart failure will require consultation with a cardiologist
prior to transplantation. Candidates with a positive stress test usually will
require cardiac catheterization and possible angioplasty or bypass.
- Treated malignancy. The cancer-free interval required will vary from
two to five years depending on the stage and type of cancer. Consultation
with a board-certified oncologist is required in these cases.
- Substance abuse history. Patients must present evidence of involvement
in 12 months of drug-free rehabilitation. This includes written documentation
of participation in rehabilitation including negative random toxicologic screens.
- Chronic liver disease. Candidates with chronic hepatitis B or C or
persistently abnormal liver function testing must have hepatology consultation
prior to consideration.
- Structural genitourinary abnormality or recurrent urinary tract infection.
Urologic consultation is required prior to consideration.
- Past psychosocial abnormality. Master of Social Work (MSW) or psychiatry
evaluation, as appropriate.
- Aortoiliac disease. Patients with abnormal femoral pulses or
disabling claudication, rest pain or gangrene will require evaluation by a
board-certified vascular surgeon prior to consideration. Patients with
significant aortoiliac occlusive disease may require angioplasty or aortoiliac
grafting prior to transplantation. In most cases, this consultation will be
performed by Stephen Bartlett, M.D., the director of transplantation, who is
board certified in vascular surgery (American Board of Surgery, certificate of
added qualifications in vascular surgery #100002). Patients with significant
aortoiliac occlusive disease may require angioplasty or aortoiliac grafting
prior to transplantation.
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January 31, 2011.