**4. Waiting list for pancreas transplantation**

#### **4.1. Evaluation of candidates**

Evaluation of the candidates for pancreas transplantation should be performed as early as possible, in order to identify those who would benefit the most from the procedure. In patients with chronic kidney disease, we recommend referral to a pancreas transplant center as soon as glomerular filtration rate (GFR) falls below 25–30 ml/min. This early referral offers precious time for patient evaluation and possible inclusion on the waiting-list pre-dialysis. Additionally, and depending on transplant center policies, this allows the study of a possible living kidney donor and a preemptive kidney transplant.

perform the appropriate treatment prior to transplantation (either angioplasty or coronary artery bypass graft—CABG). A recent acute miocardial infarction, untreatable significant coronary angiography lesions, or severe ventricular dysfunction are contraindications to

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• Vascular evaluation: an angio-computed tomography (CT) should be performed to rule out vascular lesions, mainly at the level of the iliac vessels and the celiac trunk that could hinder the implantation of the grafts. In pre-dialysis patients, a magnetic resonance imaging

• Assessment by the transplant team: once the study of potential candidates has been completed, and before being included on the waiting list, it is advisable to carry out a joint assessment by all the members of the transplant team (nephrologist, endocrinologist, anes-

At the time of inclusion on the waiting list, a checklist should be performed to ensure all pretransplant studies have been completed, and revised by the medical team. It is important to ensure that the patient has received a clear and comprehensible information regarding the advantages, as well as of the possible complications of the transplant, so that he can decide to

Logistical issues should also be discussed in advance with the patient, in order to minimize the time from patient contact to the surgical procedure (hence cold ischemia time). The patient and his closest relatives should be aware of the expected duration of the intervention, median

Also, and for as long as they remain on the waiting list, the patient should be made aware of the importance of maintaining regular communication with the transplant center. The high incidence of complications that may occur in these diabetic patients, especially if they are affected by chronic renal failure and are also waiting for a simultaneous kidney transplant, requires strict monitoring and follow-up as long as they are not transplanted. Ideally, they should be visited by a member or collaborating doctor of the transplant team every 3–4 months. Only in this way, it is possible to detect possible events that may represent a

Solid organ allocation protocols are the major influence on patients' waiting-list vintage. In the UK, the introduction of a new nationwide allocation system in December 2010 significantly reduced the number of long-lasting patients and increased the number of islet transplants [11]. These protocols must comply with national legislations and logistic constraints. Several factors must be taken into account, such as donor demographics, donor center, geographical proximity to transplant center, and recipient priority indexes. In the UK protocol, weighting factors included expected organ travel time, recipient sensitization, dialysis vintage, waiting-list time,

hospital stay, and most important post-transplant cares and outpatient visits.

(MRI) with no or low dose of low-risk gadolinum contrast can be used.

transplantation (**Table 3**).

thesiologist, and surgeons).

**4.2. Inclusion on the waiting list**

freely choose this form of treatment.

temporary contraindication for the intervention.

**4.3. Pancreas allocation**

Patient evaluation and clinical workup is similar to that performed for kidney transplantation, such as complete medical history, immunological study, uremic state, liver disease, cancer and infection screening, with some additional particularities related to diabetic disease: hormonal study, β cell autoantibodies, as well as study of the main diabetic complications.


perform the appropriate treatment prior to transplantation (either angioplasty or coronary artery bypass graft—CABG). A recent acute miocardial infarction, untreatable significant coronary angiography lesions, or severe ventricular dysfunction are contraindications to transplantation (**Table 3**).

