Posted by John on 6/15/2003, 1:51 pm, in reply to "Re: RISKS" (Solitary pancreas transplant, pancreas transplant alone, pancreas after kidney) 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 diabetic ketoacidosis. http://www.umm.edu/transplant/pancreas/indpanc.html Also:
Was this specifically a transplant surgeon? I agree that they surgery is not to be taken lightly, but darn it, that is just not the way things work in most places.
Indications for Pancreas Transplantation
Pancreas transplant candidates generally demonstrate some degree of retinopathy and may also have cataracts or glaucoma. During the ophthalmic examination, candidates are asked about blurry or double vision; seeing rings, flashing lights, blank spots, dark spots, or floating spots; pressure or pain in the eyes, and loss of peripheral vision. Diabetic retinopathy may occur without these signs, so a yearly ophthalmic assessment is recommended. The severity of retinopathy is determined from 7-field fundus photographs. Based on these photographs, retinopathy is graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, which was also used, in a modified form, in the Diabetic Control and Complications Trial. A grade is assigned for each eye based on the severity of diabetic retinopathy for each lesion. Characteristics that are graded include: new vessel development, presence of hard and soft exudates, arteriovenous nicking, retinal elevation, vitreous hemorrhage, macular edema, retinal thickening, microaneurysms, drusen, papillary swelling, hard exudate rings, macular hole, subretinal hemorrhage, and presence of a deep pale spot at the center of the macula. The retinopathy "step" or "level" for each individual is derived by calculating the scores for each eye, giving the eye with the highest level greater weight.
http://www.medscape.com/viewarticle/436542_8
Is there another surgeon you can consult or a different transplant center you can talk to?
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