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[IP] text of attachments previously emailed

Here is the text from the attachments I emailed previously (regarding islet tx 
in Memphis), for those who could not open the documents.  

The inclusion criteria include men and women with Type 1 diabetes for greater 
than five (5) years, between the ages of 18-55, with a BMI of 28 or less, with 
difficulty controlling blood glucose resulting in metabolic instability.  C-
peptide must be <0.48 ng/ml, and urine creatinine clearance must be >50 
cc/minute with microalbuminuria <300 ug/min. 
Exclusion criteria include anyone with untreated diabetic retinopathy, 
hyperlipidemia uncontrolled by medication, uncorrectable cardiovascular 
disease, active infection, liver disease, gallstones, previous transplant 
recipients, malignancy, or anyone currently smoking or using recreational 
To conduct this assessment, we will need the following laboratory tests done 
and results faxed or mailed to our office at:
Transplant Clinical Pharmacotherapy Research Institute
920 Madison Avenue, Suite 520
Memphis, TN 38104
Fax 901-448-2631
These laboratory tests include:

Serum creatinine, BUN, glucose, liver function profile, Hemoglobin A-1C, 
complete blood count, platelets, PSA, HBsAg, HBsAb, HBcAb, hepatitis C, and HIV 
serology, UA, and stool guiac X3

The other results we need are a recent ophthalmic evaluation determining 
diabetic retinopathy status. 
Please contact the Islet Transplant Coordinator at 1-901-448-2633 or e-mail at 
email @ redacted if you have any additional questions.  

We appreciate your inquiry about our islet transplant program.  At this time, 
we are screening interested islet candidates in a two-step manner.  Interested 
individuals are asked to complete the attached health history survey and 
forward requested laboratory tests to the Transplant Team as part of the 
initial screening process. Once we receive this information, we will review 
each islet candidates record, determine insurance coverage, and contact them 
regarding eligibility for transplantation and arrange a pre-transplant 
evaluation on-site. 

As you may be aware, the transplant program in Memphis was started in 1970 and 
has successfully completed over 1500 kidney, 500 liver, and 300 pancreas and 
kidney-pancreas transplants with world-class results. We have had a special 
interest in the area of diabetes, diabetic complications, and in treatment of 
diabetes by transplantation. Although excellent results have been obtained with 
whole organ pancreas transplantation at our institution, we have continued to 
investigate methods for improving human islet transplantation. Recently, 
researchers at Edmonton reported that human islet transplantation resulted in 
euglycemia and normalization of glycosylated hemoglobin (HgBA1C) in 15 Type I 
diabetes without concomitant kidney failure. A steroid-free anti-rejection 
medical protocol was used. 

The islet transplant group in Memphis is currently one of five Islet Cell 
Resource centers funded by National Institutes of Health for pancreas 
procurement and islet isolation. Our program has recently secured FDA approval 
for our clinical islet transplant protocol and is in the process of screening 
applicants for transplantation. We intend to use the Edmonton protocol for our 
next 10 islet transplants and have developed some exciting monitoring 
techniques to improve monitoring of islet function in our recipients. 
 Please find enclosed a health history survey and a letter for you to forward 
to your primary care physician. Your prompt completion of the survey and 
laboratory tests will enable us to properly and efficiently evaluate you as a 
potential transplant candidate. Please complete the health history survey and 
return to us at the following address:
	Islet Transplant Program
University of Tennessee Health Science Center
920 Madison Avenue, Suite 520
Memphis, TN  38103
Currently insurance coverage is doubtful for islet transplants, therefore 
patients will be expected to be able to absorb some of the costs for the workup 
and the transplant procedure as well as the costs of anti-rejection medications.
Thank you for your interest in the University of Tennessee Islet Transplant 
Barbara A. Culbreath, RN, BSN
Coordinator - Islet Transplant Program
As a diabetic individual, a significant portion of your life has been spent 
managing your disease as directed by a physician.  Now, due to a great deal of 
research, another forms of treatment exists for diabetes; those treatments 
include PANCREAS and ISLET CELL TRANSPLANTATION.  This brochure will provide an 
overview of diabetes, the history of pancreas and islet transplantation at our 
center, who may be eligible for a pancreas transplant, a description of the 
pancreas and islet transplant procedure, and follow-up care.

In 1998, The University of Tennessee Health Science Center celebrated the 30 
year anniversary of its solid organ transplantation program.  

The University of Tennessee Organ Transplantation Program was established in 
1968.  In April 1970, the first kidney transplant was performed and the 
University of Tennessee became the 6th program in the nation to transplant 

Since then, the program has performed more than 1,800 kidney transplants and 
can boast as one of the most successful survival rates in the US.  At present, 
the first year patient survival rates are above 95% and 5 year rates are over 
90%.  Kidney transplant success rates are 90% at 1 year and 80% at 5 years 
after transplant.  

In 1982, The University of Tennessee Health Science Center initiated liver 
transplantation and became the third liver transplant program in the US.  Since 
then, we have performed over 400 liver transplants with survival rates of over 
90% at 1 year and 80% at 3 years.  During the past 3 years, we have initiated 
the split liver transplant program and the living donor liver transplant 
program.  We have performed over 20 living donor liver transplants making us 
one of the most active and successful living donor liver transplant center in 
the nation.  

In April 1989, the first simultaneous kidney-pancreas transplant was performed 
in the state of Tennessee. In January 1990, The University of Tennessee Health 
Science Center became one of the first programs world-wide to perform solitary 
pancreas transplantation, offering new hope to diabetic patients.  

In 1992, a new technique for transplanting the pancreas using the portal-
enteric drainage was developed by our group.  This technique allows for a more 
physiological delivery of insulin and drainage of digestive enzymes from the 
pancreas.  Since then, various transplant centers in the US have adopted our 

The University of Tennessee Health Science Center recently became the 10th 
program in the US (and 13th program worldwide) to perform more than 200 
pancreas transplants.  We are currently 1 of the 7 largest pancreas transplant 
programs in the country, having performed over 200 simultaneous kidney-pancreas 
transplants and over 90 pancreas alone transplants.  

Concurrently, we established our islet transplant laboratory in 1994 and 
performed our first islet cell transplant in 1995.  In September 2001, the 
National Institute of Health identified the University of Tennessee Health 
Science Center as one of the six Islet Cell Resource centers in the US as a 
referral center for human islet cell isolation and clinical transplantation.

Diabetes is a disease resulting from the loss of the bodys ability to produce 
or respond to insulin.  Insulin is required to control the glucose (sugar) 
levels in the blood. Exposure of the body to high glucose levels over several 
years or more leads to vascular (blood vessels) disease, coronary heart 
disease, kidney disease and damage to the eyes and nerves.

There are 16 million diabetics in the United States (US) today, costing more 
than $105 billion annually or about $1 in every $10 spent on health care.  
Diabetes afflicts about 6% of the general population in the US, and is 
currently the third most common disease and the fourth leading cause of death 
by disease in the US.  There are 2,200 new cases of diabetes diagnosed every 
day in the US.  Diabetes accounts for over 160,000 deaths per year, including 
3,000 deaths per year in the state of Tennessee.  Diabetes is the leading cause 
of blindness, kidney failure, non-traumatic limb amputation, impotence in 
adults, and ranks among the leading chronic diseases of childhood.  In 
addition, diabetes can lead to a greater risk of heart attacks, strokes, 
infections, and gastrointestinal disturbances.  

The loss of glucose control in diabetics is caused by either a lack of insulin 
(Type 1 diabetes) or the bodys resistance to the effects of insulin (Type 2 
diabetes).  Approximately 10 percent of diabetics have Type l diabetes and 90 
percent have Type 2.

Type 1 diabetes is caused by the death of the insulin-producing beta cells in 
the ISLETS of Langerhans (Clusters of beta cells) in the pancreas. These cells 
sense the glucose level in the blood and produce an appropriate amount of 
insulin so that the body can use the sugar properly.  Type 1 diabetes mainly 
occurs in young people, although it may also occur in older adults. The 
symptoms usually appear quickly and include hunger, thirst, urination, weight 
loss and fatigue.

Type 2 diabetes is caused by the body improperly using insulin that is produced 
by the beta cells in the islets of Langerhans in the pancreas. The symptoms 
usually develop over a longer period of time and include increased hunger, 
thirst and urination, blurred eyesight, fatigue, numbness or tingling in hands 
or feet, frequent infections and slow healing cuts or sores.

Insulin injections and insulin pumps
Insulin injection is the most common therapy for diabetes. The use of an 
insulin pump provides the delivery of small amounts of fast-acting insulin 24 
hours a day into the body via a small needle or soft tube. Unfortunately, even 
the most careful form of insulin therapy cannot copy the precise blood sugar 
control that a working pancreas can. 

Insulin injections often offer poor sugar control, placing a patient at 
significant risk of developing diabetic complications (blindness, kidney 
failure, limb amputation, vascular disease, coronary heart disease and cerebral 
artery disease) and hypoglycemic episodes or insulin reactions.

Pancreas and islet cell transplantation
Although insulin therapy is life-saving for many diabetic individuals, a number 
of diabetic individuals on long-term insulin therapy will eventually develop 
some or all of the complications of diabetes previously mentioned.   

When considering the probability that a diabetic individual will experience 
some of the complications of diabetes, either a pancreas or an islet cell 
transplant is an option to seriously consider.  

Normally, insulin is produced by beta cells within the Islets of Langerhans 
(clusters of beta cells) which reside in a digestive organ called the 
pancreas.  Healthy islet cells (insulin producing cells) respond to the bodys 
blood sugar level from moment to moment, releasing just the right amount of 
insulin and preventing complications caused by blood sugar imbalance.  

Type 1 diabetic individuals do not have healthy islet cells in their pancreas, 
so insulin injections are taken at specific times during the day, in an attempt 
to control their blood sugar levels.  Unfortunately, due to the many different 
variables, diabetic individuals experience erratic blood sugar levels 
(many highs and lows).  The complications of diabetes generally result from 
these erratic blood sugar levels.  While an individual with diabetes can often 
control their diabetes reasonably well with insulin, there are some patients 
where only a normal pancreas with healthy islet cells can effectively control 
blood sugars to prevent these complications.  

The pancreas also performs a number of other important digestive functions 
besides blood sugar control.  In a diabetic individual, all of these other 
functions are preserved except for the ability to produce insulin from the 
islet cells. Therefore, 2 possible ways of treating diabetes are either to 
transplant the entire pancreas, or just the islet cells.  

Pancreas Transplantation
The average waiting time for a pancreas transplant is 6 to 12 months, due to 
the critical shortage of donor organs in the US.  During this time, people on 
the waiting list continue to perform their normal activities of daily living.  
Some may be asked to lose weight or to quit smoking.  

Donor organs are obtained from stable, heart-beating individuals who have been 
declared brain-dead due to an unfortunate traumatic event.  In all cases, 
consent has been obtained from the donors family or next of kin for organ 
donation.  Extensive testing is performed on the donor, not only to document 
that the removed organs are functioning normally, but also to ensure that 
disease is not transmitted by the transplant process.  

Donor organs are matched to the recipients based on blood type, tissue type, 
medical needs, and length of time on the waiting list.  Once a pancreas is 
removed from a stable donor, the team has about 24 hours in which to safely 
perform the transplant.  During this time, laboratory testing is done between 
the donor and potential recipient to determine compatibility.  

By the time that the potential recipient is called into the hospital for the 
transplant, most of the compatibility testing is completed. Final testing is 
performed to verify donor and recipient compatibility, and the patient is 
prepared for the surgical procedure.  The operation takes approximately 3 to 5 
hours, depending on whether the patient is receiving a pancreas only or a 
simultaneous kidney-pancreas transplant.  

During the transplant procedure, the individuals own pancreas is not removed, 
as he or she receives a second pancreas.  Patients are usually off of insulin 
within a few days, and remain completely insulin free long-term.  Patients 
spend about 1 to 2 days in the Intensive Care Unit and 7 to 14 days in the 
hospital.  During this time, they are educated about the change from having 
diabetes to becoming a transplant recipient.  

Transplant recipients will be on a number of new medications to prevent 
rejection and infection.  Although the commitment to transplantation is long-
term, most patients experience a straight-forward transition to becoming a 
transplant recipient with fewer dietary and activity restrictions and an 
enhanced quality of life.  Because the trade-off of transplantation is being on 
anti-rejection medications rather than on insulin, transplant recipients are 
followed long-term in the outpatient clinic by the transplant team. 

A pancreas transplant can provide sustained and fully effective insulin 
secretion for many years. The benefits of a successful pancreas transplant 
include, in most cases, improved quality of life due to decreased dietary 
restrictions and normal glucose control with freedom from insulin injections.

The long-term goal of pancreas transplantation is prevention of late 
complications of diabetes such as kidney failure and damage to the eyes, nerves 
and blood vessels. A pancreas transplant will stabilize, and in a small number 
of patients, improve eye disease. Nerve disease also improves in most patients 
with a successful pancreas transplant.  Additionally, there is evidence that 
the transplanted kidney is protected from diabetic damage by a successful 
pancreas transplant.

(Figure for pancreas transplant surgery)
 Islet Transplantation
Islet transplantation is a minimally invasive procedure that requires a one-
hour operation, a three-inch abdominal incision and a one-day hospital stay. 
Islets are obtained from a donor pancreas using a complex isolation and 
purification process in which enzymes break down the tissue surrounding the 

The islets of Langerhans are embedded within the pancreatic tissue and require 
a special, highly technical process to extract them from the pancreas.  Islets 
are usually transplanted by injecting them into the veins leading to the liver 
(the portal vein).  The islets migrate to the liver where they reside and 
produce insulin. Because pancreatic exocrine tissue is not transplanted during 
islet transplantation, complications related to digestive enzyme drainage are 


 Evaluation Process for Pancreas/ Islet Transplantation
The decision about whether a patient should receive a pancreas or an islet 
transplant is complex and requires a full medical evaluation and input from 
several medical professionals. The final decision about whether a patient 
should receive a whole organ or islet transplant can be made only after a full 
medical evaluation is completed.  

Potential candidates are assessed in a pre-transplant medical evaluation.  This 
evaluation begins when a diabetic individual or health care professional calls 
the transplant office and requests information regarding either islet or 
pancreas transplant.  The evaluation process begins by you, the diabetic 
individual, answering a questionnaire, which will help the transplant team to 
decide if you are eligible to be a potential candidate for transplant.  

When a potential candidate is identified, the transplant nurse coordinator 
arranges a time for the individual to visit the transplant center.  During the 
initial visit, detailed information is provided about pancreas and islet 
transplantation.  Family members or friends are welcome.  The individual then 
meets with the transplant surgeon who discusses the option of pancreas and 
islet cell transplantation.  If the surgeon feels that the individual may be 
appropriate candidate for transplantation, further visits are arranged for a 
thorough medical evaluation.  

Potential candidate for transplantation will receive a complete medical 
evaluation with a number of tests including: laboratory tests for viruses 
(hepatitis, herpes, AIDS, etc.), stomach X-rays, gallbladder ultrasound, 
bladder X-rays, EKG (heart rhythm), chest X-rays, dental evaluation, eye exam 
(to determine the status of eye disease) and a thallium stress test (heart 
treadmill). A pelvic exam with Pap smear and a mammogram are required for 
female candidates.  Other preliminary tests may include non-invasive vascular 
studies to determine the severity of diabetes complications on the blood 
vessels to your legs and brain and electromyelogram (EMG) to determine the 
severity of diabetes complications to the nerves of your extremities.  You may 
be requested to undergo a glucose tolerance test or metabolic studies as part 
of your pre-transplant evaluation.

The individual may meet with a diabetes specialists, kidney specialist, 
pharmacist, financial coordinator, and social worker.  If the evaluation 
results indicate that the individual would be an appropriate candidate for 
either a pancreas or islet cell transplantation, and appropriate financial 
arrangements have been made, that individual is then placed on the recipient 
waiting list after transplant committee approval.

Patients are eligible for Pancreas Transplantation if they have Type 1 
diabetes, are between the ages of 16 and 55 and have:
&#61623; Autonomic neuropathy (degenerative disease of the nervous system). These 
patients usually experience loss of appetite, bloating after eating, nausea, 
vomiting, gastric discomfort, constipation or diarrhea and urinary bladder 
&#61623; Poorly controlled diabetes, despite an appropriate insulin regimen. Such 
patients experience wide variations in their blood sugar.
&#61623; Repeated hypoglycemic (low blood sugar) episodes requiring emergency 
&#61623; Repeated bouts of ketoacidosis (a condition where acid builds up in the 
 Patients are NOT eligible for Pancreas Transplantation if they have any one of 
the following: 
&#61623; Presence of active infection.
&#61623; Cancer that is not cured or does not have a high chance of cure.
&#61623; Alcoholism or other chemical dependency.
&#61623; Unstable or advanced heart disease.
&#61623; Presence of severe peripheral vascular disease (poor blood flow to arms and 
&#61623; Not complying with prescribed medication therapy.
&#61623; Severe lung disease.
 Patients are eligible for Islet Cell Transplantation if they have Type I 
diabetes with duration of diabetes > 5 years and between the ages of 18 to 55 
years and have:
&#61623; Serum C-peptide < 0.48 ng/ml (0.16 nmol/L)
&#61623; 24-hour urine for creatinine clearance > 50 cc/minute
&#61623; 24-hour urine for microalbuminuria <300 ug/min 
&#61623; Difficult to control diabetes resulting in severe hypoglycemia with coma or 
metabolic instability 
&#61623; Ability to take medications and comply with an immunosuppression (anti-
rejection) regimen
&#61623; Endocrinologist committed to the procedure
&#61623; Men and women (men and women of childbearing years must agree to use 

Patients are NOT eligible for Islet Transplantation if they have any one of the 
&#61623; Uncorrectable heart disease with symptoms of > Stage III New York Heart 
&#61623; Active infection (including hepatitis B or C, HIV, or tuberculosis)
&#61623; Known hypersensitivity to sirolimus or tacrolimus
&#61623; Previous kidney, liver or heart transplant
&#61623; Pregnancy or unwilling to use birth control; breast-feeding females
&#61623; Malignancy
&#61623; Recent history of substance abuse or current smoker
&#61623; Hyperlipidemia uncontrolled by medication while on immunosuppressant regimen 
(sirolimus and tacrolimus) for one month pre-transplant
&#61623; Untreated diabetic proliferative retinopathy
&#61623; Psychogenic factors that effect compliance to medical management
&#61623; Panel reactive protein (PRA) > 20%
&#61623; Active peptic ulcer disease
&#61623; Symptomatic gallstones
&#61623; Liver diseases
&#61623; Overt microalbuminuria > 300ug/min
Waiting for a donor organ and preparing for transplantation
Because we never know when a donor organ will be available, the patient who is 
to receive the transplant must be ready on short notice. Patients waiting for a 
pancreas or islet transplant must make several telephone numbers available to 
the transplant coordinator and wear a pager, so they can be alerted when an 
organ is available. All potential recipients must be prepared for immediate 

You will be instructed not to drink or eat from the time you are notified of a 
pending transplant. Periodically check your finger stick glucose levels and 
notify the transplant team should your blood sugar rise over 300 or fall below 

You will be admitted to the transplant floor where you will be examined by one 
of the transplant surgery residents or surgeons and your blood profiles will be 
reviewed to ensure that you are ready for transplantation.   
Care after Pancreas Transplant Surgery
Combined pancreas-kidney and solitary pancreas transplant patients are taken to 
the Intensive Care Unit (ICU) immediately after surgery. The average stay in 
ICU is one to two days. You are then transferred to the transplant unit. You 
will receive intravenous fluids since you will not be able to ingest fluids by 
mouth for some time. A nasogastric tube is inserted through your nose into your 
stomach during surgery to allow the intestines to rest. This tube is usually 
removed after three days. During surgery, a catheter is placed into your 
bladder to check urinary output. Two small drainage tubes are placed near the 
incision during surgery, and are removed before you go home.

Pain medications will be given as needed. The immunosuppressive drugs to help 
prevent rejection will be started during the surgery.  

Blood sugars are checked frequently to assess the function of your new 
pancreas. Bed rest is ordered for approximately 24 hours, after which you may 
sit in a chair with assistance.  You will have blood work done daily to check 
kidney function and pancreas function. Hospital stays usually average about 
seven days.

Care after Islet Cell Transplant Surgery
After infusion of the islet cell, you will be taken to the transplant floor.  
Pain medications will be given as needed. The immunosuppressive drugs to help 
prevent rejection will be started during the surgery.  Your blood sugars are 
checked frequently to assess the function of the islet cells.  In order to 
reduce stress put on the islet cells during the first few days after the 
transplant, we may need to give you small doses of insulin.  You will also have 
blood work done to check your liver function and blood chemistries.  You will 
be able to eat a regular diet the same day and be sent home the following 

What to expect when you return home after pancreas or islet cell transplantation
Once you are home from the hospital, you can set goals for your return to an 
active life. Activities such as walking, jogging, hiking, bicycling, tennis, 
golf and swimming can help you regain your strength. Renewing intimate 
relationships, strengthening old friendships, meeting new people and returning 
to work will also help boost your self-confidence and sense of well-being. 

It is important after your transplant to have regular checkups with physicians 
such as your ophthalmologist, gynecologist, dentist and dermatologist. Be sure 
to let them know that you have had a transplant and what medications you are 

Wear a bracelet or necklace designating that you are a transplant patient and 
give them your transplant physicians emergency phone number. Your dentist 
should be aware of your condition so that antibiotics can be used to prevent 
possible infection when dental work is done.

Many patients are able to return to work within a few months after the 
transplant. For islet cell transplant recipients, you may be able to return to 
work the next day after discharge from the hospital.  We can keep your employer 
informed about when you can return to work, and if there are any limitations on 
what you may do. 

After your transplant, you will receive low-fat, low-sugar diet guidelines. You 
will also need to drink extra fluids to prevent dehydration, especially in the 
summer. You will have a tendency to gain weight because of increased appetite 
from some of the medications. Excessive weight gain can increase your blood 
pressure, so it is important to keep your weight under control.

It is normal to have some emotional ups and downs during this process. However, 
it is important to keep a positive outlook. If you find yourself feeling down, 
please do not hesitate to talk about it with your nurse and doctors. The social 
worker can come to talk to you also. This feeling is a normal reaction for some 

Your follow-up visits will be at the Transplant Outpatient Clinic located on 
the fourth floor at the 920 Madison Building.  Immediately after you are 
discharged from the hospital, you will need to go to clinic on Monday, 
Wednesday and Friday. As you get stronger, the frequency of your check-up 
visits will decrease. 

Please arrive between 8 and 8:30 a.m. on the day you are scheduled for clinic. 
Physicians, the transplant coordinator and, if appropriate, a dietitian, a 
pharmacist, and a social worker will see you during your visit.  Bring your 
medication list to each visit. You will be notified if a urine sample is needed.

At your follow-up visit you will sign the roster at the desk when you arrive 
and wait until you are called. A phlebotomist will draw your blood. You will be 
weighed, have your temperature taken and may be asked to provide a urine 
sample. Your name will be called when it is your turn to see the physicians.

Generally, you should be finished with the appointment by noon. Make sure you 
do not miss an appointment, because it is very important that your medical 
condition be carefully monitored. 
After your transplant, you will need to take several medications to prevent 
rejection as your body thinks that the new pancreas or islet cells are 
foreign materials and will want to destroy it.  You will likely be on these 
medications for the rest of your life or while your pancreas or islet 
transplant is functioning well.  

These medications called immunosuppressives or anti-rejection medications also 
lowered your bodys ability to fight infection, thus you will be on medications 
to prevent infections.  Patients should be aware of the increased incidence of 
infection and seek early treatment from the physician.

While successfully transplanted patients may lead nearly normal lives, they 
must have a life-long commitment to taking medications faithfully and having 
frequent check-ups. Immunosuppressive drugs must be taken every day, and it is 
critical to never miss a dose. Research continues for improvement of anti-
rejection medications and reductions of side effects. 

You should never avoid taking your medicine or reduce your dose on your own. To 
do so invites a great risk of rejection and losing your transplant. Your 
physician will be able to answer questions about specific side effects and 
adjust your medications if needed. Side effects of these medications usually 
depend on the dose of the drug and can be managed with dosage adjustment or 
changing to other medications. 

A list of these medicines and some of their side effects is included below. 
Trade Name	Generic Name	Possible Side Effects
Neoral	Cyclosporine	Flushing, kidney toxicity, hair growth, shaking, sleep 
Prograf	Tacrolimus	flushing, kidney toxicity, shaking, sleep disturbances
Cellcept	Mycophenolate Mofetil	nausea, diarrhea, abdominal pain, low 
blood counts
Imuran	Azathioprine	low blood counts

Rapamune	Sirolimus	diarrhea, high cholesterol

Deltasone	Prednisone	weight gain, acne, bone loss, cataracts, poor 
wound healing
Rejection is the bodys natural response to the presence of foreign tissue. 
Only about 20 percent of patients experience a rejection episode.  It is 
understandable to be depressed or discouraged at the time of rejection, but you 
should realize that rejection episodes are a common part of the transplant 
procedure and can be reversed. If rejection occurs after you have gone home, 
the physician may want to readmit you to the hospital so you can be watched 
more closely during treatment. 

Many transplant recipients experience complications besides rejection. Most are 
minor, but others may be serious. You will get very close medical supervision 
to detect and treat complications as soon as possible. It is vital that you 
notify your physician of any signs of infections, such as a cold, cough, sore 
throat, fever, chills and skin rashes. Infection can be a serious complication 
following a transplant, though most infections are effectively treated with 

Remember, rejection, infection and other problems can usually be treated 
quickly and effectively if detected early.

Financial considerations
Along with receiving a bill for services provided by your transplant team, you 
may also receive separate statements for services provided by specialty 
physicians involved in your care and departments like Laboratory Medicine and 
Radiology, which conduct important testing during your hospital stay and 
outpatient visits. 

Hospital costs related to the kidney transplant are usually covered by your 
insurance or Medicare. The pancreas portion of the hospitalization is not 
always covered by private insurance. In some cases, Medicare does cover it. If 
your insurance company has a transplant rider, pancreas transplants are 
usually covered.

Currently, islet cell transplantation is not covered by most insurance 
agencies; however, alternative financial support for islet transplantation may 
be feasible.  Our financial counselor will be available to assist you with your 
financial planning.   

 Staff involved in your care
The staff involved in your care includes surgeons, nephrologists (kidney 
specialists), endocrinologists (diabetes specialists), a registered nurse who 
serves as islet transplant coordinator, transplant pharmacists, clinical nurse 
specialists (registered nurses specially trained in transplantation), a social 
worker, a dietitian, surgical and medical residents (physicians in training), a 
transplant administrator and laboratory personnel.

During your pre-transplant visit to UT Bowld Hospital and the Pre-Transplant 
Evaluation Clinic (920 Madison), the transplant team will provide you with 
information about your pre-transplant evaluation, the operation, medications, 
hospital stay and financial considerations. Our goal is to treat you with 
consideration while providing excellent medical care. As a candidate for 
pancreas or islet transplantation, you and your family will be involved in all 
aspects of your evaluation and treatment process. 

If you require any additional information, you can email us at email @ redacted 
or call us at 901-448-2630

We are asking that the people getting on the islet cell transplant list have 
the resources of $20,000-25,000 for any post-surgical financial obligations. 
Our center is making every attempt to get the hospital and doctors to cover 
much of the cost for early recipients, but there will be costs not covered. The 
medication is costly ($1200 - $1500 per month). We do not know if insurance 
companies will cover these costs
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