Pancreas Transplantation Workup

Updated: Apr 13, 2022
  • Author: Joseph Sushil Rao, MD; Chief Editor: Ron Shapiro, MD  more...
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Workup

Pancreas Transplant Candidate Evaluation

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.

Pretransplant cardiac risk screening is needed in all pancreas transplant candidates. At a minimum, a 12-lead electrocardiogram and ECHO are required. Given risk factors for CAD, most patients will require stress testing or anatomic study of potential coronary lesions. Such studies may include stress echocardiogram, stress nuclear medicine studies, coronary C.T., or cardiac catheterization. Appropriate testing is often made in conjunction with cardiology and center-specific protocols.

Laboratory studies should include blood chemistries, liver function tests, CBC count, coagulation profile, urinalysis, urine culture, and cytospin (when indicated). A C-peptide level may distinguish if the candidate has type I or type II diabetes. In addition, test for the following infections:

  • 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 reagent (syphilis)
  • HIV serology
  • Purified protein derivative (tuberculosis skin test with anergy panel, when indicated)

Imaging studies performed in the pre-transplantation evaluation are chest radiography and potentially ultrasound or computed tomography (CT) evaluation of target (iliac) vessels to look for vascular calcification or narrowing.

Determining donor human leukocyte antigen (HLA) typing, presence of anti-HLA donor-specific antibodies, 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 simultaneous pancreas-kidney [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. Early allocation allows the transplantation center performing the pancreas transplantation the choice to arrange for organ recovery and transportation. It will enable recipients to be admitted to the hospital and be prepared for surgery prior to organ recovery, thus avoiding last-minute reallocation of organs and minimizing the cold-ischemia time of the pancreas prior to implantation. Pancreas allografts do not tolerate cold ischemia as well as kidney allografts.

Ideally, the pancreas should be revascularized within 12 hours after cross-clamping at procurement. Finally, early allocation also allows identification of highly matched (zero-mismatch) donor-recipient pairs or highly sensitized recipients before procurement, minimizing cold-ischemia time if the organs need to be transported across the country.

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