Pre-transplant balance

What is it?

In order to evaluate whether or not the patient can be included in the transplant list, it is necessary to perform a series of blood and instrumental tests aimed at defining whether there are contraindications to the execution of the transplant or, in any case, aimed at evaluating any risks that the patient might run in relation to surgery and immunosuppressive therapy.

Criteria for exclusion from the kidney or pancreas transplant program are generally severe cardiac disease (dilated cardiomyopathy or ischemic heart disease), severe arterial disease (cerebral or lower extremity), severe infectious disease, or recent personal history of cancer. These are conditions that could worsen abruptly after transplantation, putting life at serious risk. Once the pre-transplant examinations are completed, the clinical picture will be discussed collectively in order to share the indications for inclusion in the definitive active list.

For islet transplantation, cardiovascular issues are not an absolute contraindication. The presence of active liver diseases (e.g. chronic viral or autoimmune hepatitis, cirrhosis) is a contraindication.

When is this exam indicated?

Pre-kidney transplantation indications and budget

Execution of the pre-transplant budget and subsequent inclusion in the kidney transplant list should be started in advanced stages of CRI (stage V) preferably before the start of dialysis.

Pre-transplant pancreas indications and balance sheet

The indications for pancreas transplantation have been defined by the Italian Society of Diabetology (SID) (Italian standards for the treatment of diabetes mellitus 2018), borrowing from the indications of the American Diabetes Association (ADA), and include:

  1. pancreas and kidney transplantation advisable after exclusion of contraindications in patients with type 1 diabetes and chronic renal failure undergoing dialysis treatment or in pre-dialytic phase,
  2. Isolated pancreas transplantation advisable after exclusion of tcontraindications and verification of preserved renal function, in persons with type 1 diabetes with:
  • history of frequent and acute complications of diabetes, such as hypoglycemia, hyperglycemia, ketoacidosis, requiring medical intervention;
  • reduced sensitivity to hypoglycemia, leading to difficulties in conducting normal activities of daily living and a high risk of hypoglycemic coma;
  • clinical and emotional problems with insulin therapy that are so severe as to be disabling;
  • obvious failure of insulin therapy to prevent acute complications of diabetes, particularly hypoglycemia.
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How is it performed?

The pre-transplant assessment includes a blood draw for the evaluation of immunological characteristics (HLA typing), hematochemical and instrumental tests such as:

  • Ultrasound abdomen complete
  • Thyroid and parathyroid ultrasound
  • TSA Doppler
  • Doppler aorto-iliac-femoral-popliteal axis
  • Rx pelvis soft parts
  • Chest x-ray
  • X-ray Orthopantomography
  • ECG-Ecocardiogram + Doppler-Myocardial scintigraphy for stress and rest or Echocardiography for stress
  • Dermatological examination
  • Mammography and/or breast echo
  • Gynaecological examination + Pap test
  • CT abdomen smc

Any additional examinations in relation to patient characteristics:

  • AngioTC aorto-iliac axis and lower limbs
  • Gastroscopy + biopsy for HP research
  • Pancolonoscopy
  • MRI brain

Before being placed on the transplant list, the patient must have vaccinations that protect him from germs that, with immunosuppressive therapy, could give serious infectious pictures.

Contraindications

There are no contraindications to the pre-transplant assessment and they can all be carried out by the Services Department of the Hospital.

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