Clinical Islet Transplantation for Adults With Type 1 Diabetes in Canada: Referral Patterns and Eligibility Assessment.

OBJECTIVES: Careful selection for clinical islet transplantation (CIT) is required because of limited organ supply and the risks for lifelong immunosuppression. However, the indications for this novel treatment may not be widely known, and selection criteria continue to evolve. We sought to describe the pattern of referrals to our centre and the most common factors determining eligibility for CIT.

METHODS: We performed a retrospective chart review of all applications for CIT received at the University of Alberta between May 2009 and April 2012. Demographics and clinical data were abstracted along with the sources of referral. Application results and reasons for eligibility or ineligibility were determined. For ineligible subjects, the primary reason for ineligibility was noted.

RESULTS: We received 246 applications (mean age 43; range, 13 to 78 years; 54% male) from across Canada. The majority (81%) were self-referrals, with the remainder coming from specialists (15%) or primary care physicians (4%). Of the applicants, 19% were deemed eligible and were accepted for waitlisting. Acceptance rates were not different between physician referrals and self-referrals (25% vs. 18%; p=ns). The main reasons for ineligibility were no indication (39%); contraindications (metabolic, 21%; medical comorbidity, 17%; psychosocial, 8%) or personal factors (15%).

CONCLUSIONS: Most referrals were received from people with diabetes, but acceptance rates were not significantly lower than for physician referrals. It will be important to increase awareness of severe hypoglycemia or glycemic lability as major indications for CIT among patients and physicians and to evaluate any impact this may have on the current acceptance rate of 19%.