Appendix A
 
Assessment and Post Transplant Testing

Basal C-peptide —C-peptide is a piece of a protein that is attached to insulin when it is produced in the body. When insulin is secreted by the pancreas, C-peptide is released into the blood stream. The C-peptide test tells us if your pancreas or your transplanted islets are producing your own insulin.

HbA1c — Provides an indication of your average blood sugar level over time.

Fasting Lipids —Amount of cholesterol in your body and the type of cholesterol. Diabetes raises cholesterol levels. You must have no alcohol for thirty-six hours and no food for nine hours before the test.

CBC & Diff — Complete blood count and differential. Tell us the levels of the various blood cells and your hemoglobin level. Hemoglobin is responsible for carrying oxygen throughout your body.

Blood Typing — Repeat of your blood typing to ensure accuracy because this is important when matching organ donors and recipients.

PT INR & PTT — Assesses clotting time.

Electrolytes — Gives the amount of electrolytes in your blood. This test provides information about kidney function.

Creatinine & BUN — Creatinine and BUN are waste products that are disposed of by the kidneys. Provides information about kidney function.

Magnesium — Magnesium is an important ion in the body that can be affected by immunosuppressive drugs.

Phosphorus — Phosphorus is an important ion in the body. It indicates kidney and bone health.

TSH —Thyroid-stimulating hormone indirectly measures your thyroid hormone levels. Low or high thyroid hormones affect your metabolic function.

Liver Function Tests — Used to assess the health of your liver.

Serology Profile — This set of blood tests tells us what infectious diseases, such as hepatitis, that you may or may not have had. We need to be sure that you do not have any infections that will be made worse by your immunosuppressant drugs or the transplanted islets. We also need to know what common viruses you may have had that now live in your body and can flare up with immunosuppression. This information helps us to guide your treatment for preventing infection. You will also be tested for human immunodeficiency virus (HIV).

Tissue Typing — Your blood is screened for antibodies that may increase your risk of rejection of donor organs. We will find out your tissue type so that we may compare it with the tissue type of your donor.

Other Tests

Urine Testing — Urine will be collected by you over a twenty-four hour period. We run several tests on this specimen that give us information about how well your kidneys are functioning.

Mantoux — Tuberculosis is an infectious disease that can flare up if you are on immunosuppressants. This test will confirm if you have or have not been exposed to TB in the past.

ECG — A tracing of the electrical conductivity in your heart. Changes in the ECG can sometimes indicate underlying disease. You will have electrodes connected to your arms, legs and chest. You will need to lie still for about thirty seconds while the testing is performed.

Mixed Meal Tolerance Test — This test measures the blood glucose and C-peptide response to a liquid meal substitute. You must not eat after midnight or take your morning insulin prior to the test. You will be given a drink (Ensure HP®) to consume within five minutes. A sample of blood will be drawn to measure glucose and C-peptide before and 90 minutes after consuming the drink. The test takes 90 minutes.

Intravenous Arginine Infusion Test — Arginine is an amino acid that stimulates insulin production. This test measures the insulin secretory reserve of your transplanted islets. An intravenous line will be started in one arm. Five grams of arginine will be injected through this line and blood will be drawn at timed intervals for measuring insulin and C-peptide levels. You must not eat after midnight or take your morning insulin prior to the test. The test takes 20 minutes.

Intravenous Glucose Tolerance Test (IVGTT) —This test measures the insulin and C-peptide response of the transplanted islets to intravenous glucose. An intravenous line will be started in one arm. Through this line about 20 grams of glucose (depending on body weight) will be injected and blood samples will be drawn at timed intervals for measuring glucose, insulin and C-peptide. You must not eat after midnight or take your morning insulin prior to the test. This test takes 40 minutes.

Oral Glucose Tolerance Test (OGTT) — This test measures glucose levels after drinking a sugary drink. You must not eat after midnight prior to the test. An intravenous line will be started in one arm. You will be given a sweet drink containing 75 grams of glucose to consume within five minutes. Blood samples will be drawn every half hour to measure glucose, insulin and C-peptide. The test takes two hours.

Abdominal Ultrasound and Doppler Flow studies — Assesses blood flow to the liver. Looks at organs within the abdomen. Takes approximately two hours.

GFR — A glomerular filtration rate test provides very specific information about how the kidneys are functioning. You will receive a radionuclide injection at the start of the test. Then, at different time intervals, your kidneys will be scanned and you will have blood drawn. This test takes approximately three hours.

Chest X-ray — A chest x-ray helps us screen for any unknown lung or heart disease. This test takes thirty minutes.

Mammography — Assesses breast for tumors. Done for women over forty years of age. You must arrange this test where you live, and the time requirement will vary.

Cardiac MIBI — A MIBI exercise stress test is both an exercise stress test on a treadmill and a scan which will take pictures of the blood supply to your heart muscle. A stress test requires you to walk on a treadmill while your heartbeat is recorded on a monitor at the same time. This test is done in two parts, each part 2-2 1/2 hours long, on two separate days  

Peripheral Sensory Assessment — Measures nerve function. Part of initial clinic assessment.

Coronary Angiogram — Performed where other cardiac tests suggest that there may be narrowing in the arteries around your heart. Determines if your heart is fit to undergo the strain of transplant. This test looks at the vessels of the heart through a catheter that is threaded through your veins. It is important to be sure that your heart is clear of any blockages before we complete the transplant. For this test, you will need to be referred to a cardiologist for assessment. If you are from out of town, this can be done close to your home.

Other Tests — Every patient is different with their own unique health profile, thus some patients require other tests or specialist consults to address their health concerns. You will be informed of any concerns we have and extra tests that may be required.