Pancreas Transplantation Workup

  • Author: Dixon B Kaufman, MD, PhD; Chief Editor: Ron Shapiro, MD   more...
 
Updated: Sep 1, 2011
 

Laboratory Studies

Pretransplantation recipient laboratory evaluation

The pertinent components of a complete pretransplantation recipient medical evaluation are outlined below. The emphasis of the evaluation should be to identify and treat all coexisting medical problems that may increase the rate of morbidity and mortality of the surgical procedure and adversely impact the posttransplantation course. In addition to a thorough medical evaluation, the social issues of the patient should be evaluated to determine conditions that may jeopardize the outcome of transplantation, such as financial and travel restraints or a pattern of noncompliance.

  • Blood chemistries
  • Liver function tests
  • CBC count
  • Coagulation profile

Infectious profile

  • Hepatitis B and C serologies
  • Cytomegalovirus (CMV) serologies (immunoglobulin M/immunoglobulin G [IgM/IgG])
  • Epstein-Barr virus serologies (IgM/IgG)
  • Varicella-zoster serologies (IgM/IgG)
  • Rapid plasma reagin (syphilis)
  • HIV serology
  • Purified protein derivative (tuberculosis skin test with anergy panel, when indicated)

Other

  • Urinalysis, urine culture, and cytospin (when indicated)
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Imaging Studies

  • Chest radiography (posteroanterior and lateral)
  • Exercise/dipyridamole thallium scintigraphy
  • Coronary arteriography (if indicated)
  • Stress cardiac ultrasonography (if indicated)
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Other Tests

C-peptide level confirms that transplantation candidate has type I diabetes.

A complete cardiac workup, including angiography, is not necessary in every patient. However, individuals with a significant cardiac history, positive review of systems, type I diabetes, or hypertensive renal disease should undergo a complete evaluation to rule out significant coronary artery disease. A 12-lead ECG may be needed prior to transplantation.

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Contributor Information and Disclosures
Author

Dixon B Kaufman, MD, PhD  Ray D. Owen Professor and Chief, Division of Transplantation, Department of Surgery, School of Medicine and Public Health, University of Wisconsin

Dixon B Kaufman, MD, PhD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, American Surgical Association, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Chief Editor

Ron Shapiro, MD  Professor of Surgery, Robert J Corry Chair in Transplantation Surgery, Director, Kidney, Pancreas, and Islet Transplantation, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center

Ron Shapiro, MD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons

Disclosure: Astellas Honoraria Speaking and teaching; Brystol Meyer Squibb StemCell Data Monitoring Committee Consulting fee Review panel membership; Wyeth Honoraria Speaking and teaching; Stem Cells, Inc Consulting fee Review panel membership; Up To Date contracted Author

References

  1. Demartines N, Schiesser M, Clavien PA. An evidence-based analysis of simultaneous pancreas-kidney and pancreas transplantation alone. Am J Transplant. Nov 2005;5(11):2688-97. [Medline].

  2. Ziaja J, Bozek-Pajak D, Kowalik A, Krol R, Cierpka L. Impact of pancreas transplantation on the quality of life of diabetic renal transplant recipients. Transplant Proc. Oct 2009;41(8):3156-8. [Medline].

  3. Decker E, Coimbra C, Weekers L, et al. A retrospective monocenter review of simultaneous pancreas-kidney transplantation. Transplant Proc. Oct 2009;41(8):3389-92. [Medline].

  4. McCullough KP, Keith DS, Meyer KH, Stock PG, Brayman KL, Leichtman AB. Kidney and pancreas transplantation in the United States, 1998-2007: access for patients with diabetes and end-stage renal disease. Am J Transplant. Apr 2009;9(4 Pt 2):894-906. [Medline].

  5. Sampaio MS, Poommipanit N, Cho YW, Shah T, Bunnapradist S. Transplantation with pancreas after living donor kidney vs. living donor kidney alone in type 1 diabetes mellitus recipients. Clin Transplant. Nov 2010;24(6):812-20. [Medline].

  6. Schenker P, Vonend O, Krüger B, Klein T, Michalski S, Wunsch A, et al. Long-term results of pancreas transplantation in patients older than 50 years. Transpl Int. Feb 2011;24(2):136-42. [Medline].

  7. Drachenberg CB, Odorico J, Demetris AJ, Arend L, Bajema IM, Bruijn JA, et al. Banff schema for grading pancreas allograft rejection: working proposal by a multi-disciplinary international consensus panel. Am J Transplant. Jun 2008;8(6):1237-49. [Medline].

  8. Drachenberg CB, Torrealba JR, Nankivell BJ, Rangel EB, Bajema IM, Kim DU, et al. Guidelines for the Diagnosis of Antibody-Mediated Rejection in Pancreas Allografts-Updated Banff Grading Schema. Am J Transplant. Aug 3 2011;[Medline].

  9. Browne S, Gill J, Dong J, Rose C, Johnston O, Zhang P, et al. The Impact of Pancreas Transplantation on Kidney Allograft Survival. Am J Transplant. Jul 12 2011;[Medline].

  10. Mora M, Ricart MJ, Casamitjana R, Astudillo E, López I, Jiménez A, et al. Pancreas and kidney transplantation: long-term endocrine function. Clin Transplant. Nov 2010;24(6):E236-40. [Medline].

  11. Ojo AO, Meier-Kriesche HU, Hanson JA, et al. The impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation. Jan 15 2001;71(1):82-90. [Medline].

  12. Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant. Aug 2005;19(4):433-55. [Medline].

  13. United Network for Organ Sharing (UNOS). United Network for Organ Sharing (UNOS). [Full Text].

 
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Simultaneous pancreas-kidney transplantation with enteric drainage. Illustrated by Simon Kimm, MD. Image courtesy of Landes Bioscience.
Solitary pancreas transplantation with enteric drainage. Illustrated by Simon Kimm, MD. Image courtesy of Landes Bioscience.
Solitary pancreas transplantation with bladder drainage. Illustrated by Simon Kimm, MD. Image courtesy of Landes Bioscience.
 
 
 
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