Pancreas Transplantation Workup

Updated: Dec 06, 2018
  • Author: Dixon B Kaufman, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
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Workup

Approach Considerations

The emphasis of the pretransplantation 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.

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.

Determining donor human leukocyte antigen (HLA) typing, serologies, and crossmatch results with patients on the pancreas transplantation waiting list will permit the ideal situation of allocating the cadaveric pancreas (plus kidney, with SPK transplantation) prior to procurement of the organs. 

The timing of allocation of the pancreas to a specific patient relative to the procurement of the organ has important implications. Prior allocation allows the transplantation center performing the pancreas transplantation the choice to procure the pancreas as well. It allows patients to be admitted to the hospital and the reevaluation process to begin simultaneously with the procurement of organs, rather than sequentially. The cold-ischemia time of the pancreas prior to implantation is minimized. Pancreas allografts do not tolerate cold-ischemia as well as kidney allografts. Ideally, the pancreas should be revascularized within 24 hours from the time of cross-clamping at procurement. Finally, prior allocation also allows identification of 0-antigen mismatched donor-recipient pairs before procurement, which minimizes cold-ischemia time if the organs need to be transported across country.

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Laboratory Studies

Laboratory studies should include blood chemistries, liver function tests, CBC count, coagulation profile, urinalysisurine culture, and cytospin (when indicated).  C-peptide level confirms that transplantation candidate has type I diabetes. In addition, test for the following infections: 

  • Hepatitis B and Hepatitis 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)

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Imaging Studies

Imaging studies performed in the pretransplantation evaluation are chest radiography (posteroanterior and lateral) and exercise/dipyridamole thallium scintigraphy. If indicated, coronary arteriography and/or stress cardiac ultrasonography may also be performed.

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Other Tests

 

 

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