Abstract
Background and Aims
β-cell replacement therapy, with either pancreas or islet transplantation, is a treatment option for selected patients with brittle type 1 diabetes. All patients referred to the national transplant centre for assessment of this treatment, are evaluated in the outpatient clinic before any work-up for transplantation is initiated. Before 2015, this assessment was performed by a nephrologist alone, while from 2015 the assessment has also included an endocrinologist, a transplant surgeon and a psychiatrist in a multidisciplinary team.
Method
The proportion of patients accepted for transplantation before and after the multidisciplinary approach were compared. A chi square test was used for comparing the groups in the two periods; 2010-2014 versus 2015-2019 vs. P-values are reported according to two- tailed analysis, and p- values < 0.05 were considered statistically significant.
Results
From 2010 to December 2019, 144 patients were assessed for β-cell replacement therapy eligibility. Out of all patients referred, 64 out of 79 (81%) and 22 out of 65 (34%) were listed for transplantation before and after the multidisciplinary assessment was introduced (p-value < 0.005). The main reasons for not being listed after the introduction of a multidisciplinary team were suboptimal diabetes treatment and that the patients withdrew their interest after the outpatient clinic visit with thorough information about advantages and risks.
Conclusion
The rate of patients who were accepted for islet or single pancreas transplantation declined after a multidisciplinary approach was introduced for transplant candidate eligibility. We suggest that a broader, multi-disciplinary approach revealed previously undetected medical issues and improved patient information that subsequently resulted in fewer patients listed for transplantation.
Defining outcomes for β-cell replacement therapy in the treatment of diabetes: a consensus report on the Igls criteria from the IPITA/EPITA opinion leaders workshop