Patients interested in pancreas transplantation can schedule an appointment by calling our office at (212) 659-8086. The receptionist will forward your call to the referral coordinator, and your demographic, dialysis, and insurance information will be taken. Once we have received clearance from your insurance carrier (usually within three to five business days), you will be called to schedule an appointment for an evaluation.

Outpatient Evaluation
An outpatient evaluation involves visiting our office where you will meet with several members of our transplant team. The requirements that you need to complete in order to secure a place on our waiting list that are not completed in our office that day will have to be completed after you leave our office.

If you do not live near Mount Sinai you can arrange to stay at the special residential facility nearby called the TLC (Transplant Living Center) the night before your appointment. You can request more information about this facility by calling TLC at (212) 348-3359.

The Initial Process
Beginning with the first appointment, you will undergo an extensive evaluation at Mount Sinai. The multidisciplinary kidney/pancreas team evaluating you includes nephrologists, cardiologists, transplant surgeons, social workers, transplant coordinators, and nutritionists. They will review your medical history, assess your physical conditon, and carry out a series of tests.

If you have potential living donors, we will also perform tests on the prospective donors to make sure he or she is a match.

On average, it usually takes patients approximately one to two months to complete their transplant evaluation. The length of time it takes is determined by how long it takes you to complete the necessary requirements and have them sent to us. Once the evaluation is completed your case is presented at our weekly candidate review meeting to determine if you are a suitable candidate for transplantation.

General Tests Include:

• History, including all operations, major hospitalizations, medications, results of major tests (e.g., cardiac evaluation, X-rays, scans, Dopplers)
• Chest X-ray
• EKG
• PPD
• Stress cardiac testing (e.g. Persantine-thallium, dobutamine ECHO)
• Social work evaluation
• Complete blood count, full chemistry panel, hepatitis studies, HIV screening, blood test for syphilis (VDRL), CMV, Herpes Simplex, and EBV titers, and C-Peptide
• Blood group typing, tissue typing, antibody screening, and cross-match test for patients who have living donor candidates
• Other relevant tests

For Women

• Gynecologic exam
• Pap smear
• Mammogram (if older than 40 years)

For Men

• PSA (if older than 55 years)

For Hepatitis C positive Patients

• Hepatology/ Gastroenterology consultation
• Hepatic Ultrasound
• Liver biopsy

Once you have been approved for transplant, your name will be registered with the United Network for Organ Sharing (UNOS) national computer database.

While on the waiting list, your health status is followed by yearly or every other year appointments at The Mount Sinai Medical Center. Any hospitalizations, surgeries, blood transfusions, infections, or change in address and phone numbers are updated at this appointment. Similar blood tests and heart tests are also repeated.

On average, patients wait three to four years for a kidney/pancreas transplant.

If you have a matching living donor candidate, they will undergo tests to ensure their medical suitability to donate. There are two main objectives when we evaluate a donor. One is to ensure their safety and well-being, and the other is to ensure that they are giving the recipient a good organ. Once this has been determined and the recipient has completed their work-up requirements, a transplant can be scheduled.

A living donor transplant is a scheduled procedure. You and your donor will have pre-admission testing and will be told what time to arrive the morning of surgery.

A deceased donor transplant is an unplanned or emergent procedure. You may receive a call at any time of the day or night from a transplant coordinator with instructions on where you need to go and when.

In both cases, you will need to spend 7 to 14 days for a kidney/pancreas transplant or a pancreas transplant.

The transplant surgery usually takes two to four hours. An incision about 4-10 inches long will be made above the groin area on either the right or left side. You will have an intravenous line in your arm, which is used to administer fluids and medications the first few days after surgery. You will have a catheter in your bladder for the first several days, and the nurses will make sure that you are up and out of bed as soon as you can tolerate activity.

During your recovery at Mount Sinai, we will monitor you closely, prescribe and adjust immunosuppressive medications (medications to prevent rejection of your new organ), and reverse rejection if it begins. After discharge, you will require periodic follow-up. This is a crucial aspect of a successful transplant because this is how we will monitor you for signs and symptoms of rejection and infection and will make adjustments in your medication as needed. Medications often prescribed include Mycophenolate Mofetil, Prednisone and Cyclosporine or Prograf, and a variety of antibiotics. During the first few months, this drug regimen will be monitored by our team.

During your hospital stay, one of the transplant coordinators will instruct you on your discharge medications, dosage, and side effects, your activity limitations, and monitoring of your temperature, blood pressure, weight and urine output at home.

You will have your blood tests done twice a week during the first month along with a weekly clinic visit. During the following two months, you will have blood tests done once a week and a clinic visit every other week.

After three months, you can go back to your referring physician for periodic follow-up, with input from our transplant team.

If you do not live near Mount Sinai, you may arrange to stay at the special residential facility nearby called the Transplant Living Center (TLC). You can request more information about this facility by calling the TLC at (212) 348-3359.

The Transplant Liaison is a professional healthcare position developed by Mount Sinai over two years ago to improve patient service and build strong relationships with community dialysis units.

The transplant liaisons travel to community dialysis units and provide on-site education on various aspects of transplantation and organ donation. For patients, most education takes place in small group settings. For staff, inservices are conducted and can be provided for nurses and other professional staff who require ongoing education certification. The liaison will also arrange for physician specialists from the transplant center to present topics on other aspects of transplantation, such as HIV-positive patients, research developments, and immunosuppressive protocols.

The transplant liaison helps to ensure continuity of care for any dialysis patient who is in the process of evaluation or awaiting transplantation at Mount Sinai by reviewing the dialysis records, visiting with patients, and meeting with the primary care team regarding the patient’s status.

Mount Sinai’s transplant liaisons are available to assist any patient or provider in the community regardless of institutional affiliation.

Islet transplantation is a potential cure for Type I diabetes that afflicts nearly two million persons in the United States.

Insulin-producing pancreatic islets are taken from a donor pancreas. During the transplant, the surgeon places a small plastic tube (catheter) through the upper abdomen and into the liver and the islets are then injected through the catheter into the liver. Once implanted, the islets begin to make and release insulin.

The goal of islet transplantation is to infuse enough islets to control the blood glucose level without the need of further insulin injections. Often two or more transplants are currently necessary to achieve insulin independence. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce these complications.

At this point, an islet cell transplant recipient will need to take immunosuppressive drugs for life. These medications are necessary to prevent the immune system from rejecting and destroying the transplanted islets.

Many advances in islet transplantation were made in recent years. Since reporting the findings in the June 2000 issue of the New England Journal of Medicine, researchers at the University of Alberta in Edmonton, Canada, have continued to use a protocol called the "Edmonton protocol." According to the most recent data of a multicenter trial, about 80 percent of the patients have remained insulin-free up to one year, 50 percent up to three years, and 30 percent up to four years after receiving a transplant.

Nonetheless, islet transplantation should still be considered experimental, as there are many issues relating to islet isolation, immunosuppression, and transplantation that require active research and development.

New approaches are being studied that will allow successful transplantation without the use of immunosuppressive drugs, thus eliminating the side effects that may accompany their long-term use.

The Mount Sinai Recanati/Miller Transplantation Institute is currently working on establishing a clinical islet transplant program funded by the National Institutes of Health (NIH) to make this therapy available to our patients.

The Kidney/Pancreas Transplant Program at Mount Sinai began in 1967, making this center one of the first kidney transplant programs in the region.

As of 2006, we have performed more than 1,400 kidney transplants and more than 100 pancreas or combined kidney/pancreas transplants. As part of our commitment to enhance the quality of life for patients before and after transplant, surgeons at our hospital performed the first laparoscopic donor surgery in New York State in 1996, a procedure that dramatically reduces recovery time for individuals donating a kidney to a loved one. So far, more than 500 laparoscopic donor surgeries have been performed.