Recipient assessment
The assessment phase provides an opportunity for potential recipients to receive information and ask questions about the procedure, and their suitability for it and to meet the islet transplant team.
During the initial visit, a comprehensive medical assessment is carried out. As the primary indication is severe hypoglycemia, a detailed history of the frequency and severity of hypoglycaemic episodes is taken. Particular emphasis is placed on hypoglycaemic unawareness and the need for third party assistance to manage hypoglycaemic episodes. It is preferable that the patient has trialled a pump, but this is not mandatory.
During the first consultation there will be discussion regarding the risks and benefits of islet transplantation.
If the individual has severe hypoglycaemic episodes and is interested in proceeding along the islet transplantation pathway, detailed screening will begin.
Screening
Hypoglycaemic score: A detailed logbook of blood glucose levels, food intake, exercise duration and hypoglycaemic episodes is kept, including whether each hypoglycaemic episode was symptomatic or asymptomatic, how it was treated, the time of day at which it took place and whether third party assistance was required. During this time, the islet transplant team will be in regular phone/e-mail contact. The logbook details will be used to calculate a “hypoglycaemic score” (link to hyposcoring sheet & Ryan et al) a numerical assessment of the severity of the hypoglycaemic episodes.
Medical screening: The screening process includes multiple blood and urine tests, chest x-ray, abdominal ultrasound and exercise stress test. A screen for complications of diabetes will be done, including an eye examination, renal function tests. Blood testing for prior exposure to infections such as Hepatitis B and C, EBV and varicella-zoster virus will be performed.
Immunological screening: Blood tests including blood group, tissue typing and screening for auto (GAD, IA2, ZnT8 and anti-insulin antibodies) and anti-HLA antibodies will be performed. The presence of anti-HLA antibodies prior to transplantation (usually from past child bearing or blood transfusion) may result in damage to the islets after transplantation.
Psychological screening: Living with T1DM and dealing with dietary restrictions and the need for regular glucose testing and insulin injection can be difficult. In patients who suffer multiple hypoglycaemic episodes these difficulties are magnified. For these reasons all potential islet transplant recipients meet our Islet Transplant Psychiatrist to discuss the procedure including their fears and hopes.
This preparation period gives the patient and their family time to consider what the islet transplant involves and its benefits and risks. Family members are always welcome to attend consultations.