Refer Your Patient

To refer a patient for pancreas transplant evaluation or to speak with a member of our staff, please call 1-855-EMORYTX (366-7989) – toll free number, Monday through Friday from 8 a.m. to 4:30 p.m.

The following items are required for a kidney-pancreas transplant referral to be processed:

• Completed Referral Form (PDF 80 KB)
• Recent history and physical exam and/or office visit notes
• Patient's height and weight
• Copy of front and back of patient's insurance card
• Long-term care plan
• PCP referral number on file with patient's insurance company (applies only to patients with HMO/POS managed care products and Georgia Better Healthcare)

These items can be faxed to 404-727-8972.

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.

Referral Process

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.

Eligibility Criteria

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 35, and be free from medical conditions that may affect immediate or long-term survival.

Indications for Kidney-Pancreas Transplant

• Type 1 diabetes with advanced nephropathy

• Imperfect metabolic control of exogenous insulin

Absolute Contraindications for Kidney-Pancreas Transplant

Factors which place individual at highest risk for poor outcome, poor quality of life or increased mortality.

• Malignancy within the past two years

• Lack of adequate social or family support

• Significant non-compliance with medical regimen

• Severe central vascular disease (aortoiliac)

• Severe coronary artery disease

• Severe malnutrition/cachexia

Relative contraindications for Kidney-Pancreas Transplant

Factors which place individual at moderate risk for poor outcome, poor quality of life or increased mortality.

• Active tuberculosis

• Active drug/ETOH abuse

• History of recurrent malignancy (patients free of cancer for two years will be considered)

• Advanced coronary artery disease

• Advanced chronic obstructive pulmonary disease

• Current positive crossmatch

• Severe neurologic deficits or untreatable psychiatric illness

• Lack of family or social support

Kidney-Pancreas Evaluation Process

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.

Kidney-Pancreas Transplant Listing Process

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 404-727-0717 or 1-877-509-9877.

Kidney-Pancreas Listing

For local pancreas allocation, recipients may be selected from candidates awaiting an isolated pancreas or a kidney-pancreas combination from the same donor. Recipients are matched based on HLA antigens, blood type, and wait time.

Emory Transplant Center