OPTN- Pancreas Registration

Pancreas Transplant Recipient Registration (TRR)
Record Field Descriptions
The Transplant Recipient Registration (TRR) records are generated and available immediately after a
transplant event is reported through the recipient feedback process in WaitlistSM. A TRR will also be
generated in the case of a living donor transplant, where a recipient was added through the donor
feedback process in Tiedi®. The TRR record is completed by the transplant center performing the
transplant. The registration and hospital discharge follow-up information is combined in this record.
Complete the TRR at hospital discharge or six weeks post transplant, whichever is first. If the
recipient is still hospitalized at six weeks post transplant, provide the most recent information available
regarding the recipient's progress.
The TRR record must be completed within 60 days from the record generation date. See OPTN/UNOS
Policies for additional information. Use the search feature to locate specific policy information on Data
Submission Requirements.
To correct information that is already displayed on an electronic record, call the UNetSM Help Desk at 1800-978-4334.
Recipient Information
Name: Verify the last name, first name and middle initial of the transplant recipient is correct. If the
information is incorrect, corrections may be made on the recipient's TCR record.
DOB: Verify the displayed date is the recipient's date of birth. If the information is incorrect, corrections
may be made on the recipient's TCR record.
SSN: Verify the recipient's social security number is correct. If the information is incorrect, contact the
Help Desk at 1-800-978-4334.
Gender: Verify the recipient's gender is correct. If the information is incorrect, corrections may be made
on the recipient's TCR record.
HIC: Verify the 9 to 11 character Health Insurance Claim number for the recipient indicated on the
recipient's most recently updated TCR record is correct. If the recipient does not have a HIC number,
you may leave this field blank.
Tx Date: Verify the displayed transplant date is the date of the beginning of the first anastomosis. If the
operation started in the evening and the first anastomosis began early the next morning, the transplant
date is the date that the first anastomosis began. The transplant is considered complete when the
cavity is closed and the final skin stitch/staple is applied. The transplant date is indicated immediately
after a transplant event is reported through the recipient feedback process in Waitlist and in the case of
a living donor transplant, where a recipient was added through the donor feedback process in Tiedi.
State of Permanent Residence: Select the name of the state, of the recipient's permanent address, at
the time of transplant. This field is required. (List of State codes)
Permanent Zip: Enter the recipient's zip code, of their permanent address, at the time of transplant.
This field is required.
Provider Information
Recipient Center: The recipient center will display. Verify that the transplant center name, center code,
and the provider number, (6-character Medicare identification number of the hospital where the
transplant recipient was transplanted) are correct.

Surgeon Name: Enter the name of the primary surgeon, who performed the transplant operation, and
under whose name the transplant is billed. This field is required.
NPI #: Enter the 10-character CMS (Center for Medicare and Medicaid Services, formerly HCFA)
assigned National Provider Identifier of the transplant physician. Your hospital billing office may be able
to obtain this number for you. This field is required.
Donor Information
UNOS Donor ID #: The UNOS Donor ID number, reported in the Recipient Feedback, will display.
Each potential donor is assigned an identification number by OPTN/UNOS. This ID number
corresponds to the date the donor information was entered into the OPTN/UNOS computer system.
Donor Type: The donor type, reported in the Recipient Feedback, will display. Verify the recipient's
donor type is correct. If the information is incorrect, contact the Help Desk at 1-800-978-4334.
Deceased indicates the donor was not living at the time of donation.
Living indicates the donor was living at the time of donation.
Patient Status
Primary Diagnosis: Select the primary diagnosis for the disease requiring a transplant for this
recipient. If the recipient has had a previous transplant for the same organ type, enter
Retransplant/Graft Failure as the primary diagnosis for that organ. If Other, Specify is selected, enter
the primary diagnosis in the space provided. This field is required. (List of Pancreas Diagnosis codes)
Date: Last Seen, Retransplanted or Death: Enter the date the hospital reported the recipient as living,
retransplanted (when the data was obtained prior to the recipient's discharge) or the date of the
recipient's death, using the standard 8-digit numeric format of MM/DD/YYYY. This field is required.
Patient Status: Select the appropriate status for this recipient. If Dead is selected, indicate the cause
of death. This field is required. (List of Patient Status codes)
Living
Dead
Retransplanted
Primary Cause of Death: If the Patient Status is Dead, select the patient's cause of death. If
an Other code is selected, enter the other cause of death in the space provided. (List of
Primary Cause of Death codes)
Contributory Cause of Death: If the Patient Status is Dead, select the patient's contributory
cause of death. Do not select the primary cause, since it cannot be both the primary and
contributory cause of death. If an Other code is selected, enter the other cause of death in the
space provided. (List of Contributory Cause of Death codes)
Contributory Cause of Death: If the Patient Status is Dead, select the patient's contributory
cause of death. Do not select the primary cause, since it cannot be both the primary and
contributory cause of death. If an Other code is selected, enter the other cause of death in the
space provided. (List of Contributory Cause of Death codes)
Note: If the Patient Status is Retransplanted, then Failed must be selected for the Pancreas
Graft Status.
Note: If the patient is being retransplanted, access the patient's last record for their previous
transplant and select Retransplanted in the Patient Status field. This will stop the
generation of TRF records associated with the previous transplant.
Transplant Hospitalization:

Date of Admission to Tx Center: Enter the date the recipient was admitted to the transplant
center, using the standard 8-digit MM/DD/YYYY format. If the patient was admitted to the hospital
before it was determined a transplant was needed, enter the date it was determined the patient
needed a transplant. This field is required.
Date of Discharge from Tx Center: Enter the date the recipient was released to go home, using
the standard 8-digit MM/DD/YYYY format. The recipient's hospital stay includes total time spent in
different units of the hospital, including medical and rehab. This information is not required in the
TRR record, but if entered here, it will automatically fill in the future TRF records. It is required in
the TRF record.
Note: Leave this field blank if the recipient was removed from the waiting list with a code of 21,
indicating the recipient died during the transplant procedure.
Was patient hospitalized during the last 90 days prior to the transplant admission: If the
recipient was hospitalized during the last 90 days prior to transplant admission, select Yes. If not,
select No. If unknown, select UNK.
Medical Condition at time of transplant: Select the choice that best describes the recipient's
condition and location just prior to the time of transplant. This field is required. (List of Medical
Condition codes)
In Intensive Care Unit
Hospitalized Not in ICU
Not Hospitalized
Functional Status: Select the choice that best describes the recipient's functional status just prior to
the time of transplant. This field is required. (List of Functional Status codes)
Note: The Karnofsky Index will display for adults aged 18 and older.
100% - Normal, no complaints, no evidence of disease
90% - Able to carry on normal activity: minor symptoms of disease
80% - Normal activity with effort: some symptoms of disease
70% - Cares for self: unable to carry on normal activity or active work
60% - Requires occasional assistance but is able to care for needs
50% - Requires considerable assistance and frequent medical care
40% - Disabled: requires special care and assistance
30% - Severely disabled: hospitalization is indicated, death not imminent
20% - Very sick, hospitalization necessary: active treatment necessary
10% - Moribund, fatal processes progressing rapidly
Note: The Lansky Scale will display for pediatrics aged 1 to 17.
100% - Fully active, normal
90% - Minor restrictions in physically strenuous activity
80% - Active, but tires more quickly
70% - Both greater restriction of and less time spent in play activity
60% - Up and around, but minimal active play; keeps busy with quieter activities
50% - Can dress but lies around much of day; no active play; can take part in quiet
play/activities
40% - Mostly in bed; participates in quiet activities
30% - In bed; needs assistance even for quiet play
20% - Often sleeping; play entirely limited to very passive activities
10% - No play; does not get out of bed
Not Applicable (patient < 1 year old)
Unknown
Note: This evaluation should be in comparison to the person's normal function, indicating how the
patient's disease has affected their normal function.

Physical Capacity: Select the choice that best describes the recipient's physical capacity just prior to
the time of transplant. If the recipient's Medical Condition indicates they are hospitalized, select Not
Applicable (< 1 year old or hospitalized). (List of Physical Capacity codes)
No Limitations
Limited Mobility
Wheelchair bound or more limited
Not Applicable (< 1 year old or hospitalized)
Unknown
Physical Capacity is the ability to perform bodily activities such as walking, dressing, bathing,
grooming, etc.
Cognitive Development: (This field is required for recipients 18 years of age or younger.) Select the
choice that best describes the recipient's cognitive development just prior to the time of transplant. (List
of Cognitive Development codes)
Definite Cognitive Delay/Impairment (verified by IQ score <70 or unambiguous behavioral
observation)
Probable Cognitive Delay/Impairment (not verified or unambiguous but more likely than not,
based on behavioral observation or other evidence)
Questionable Cognitive Delay/Impairment (not judged to be more likely than not, but with some
indication of cognitive delay/impairment such as expressive/receptive language and/or learning
difficulties)
No Cognitive Delay/Impairment (no obvious indicators of cognitive delay/impairment)
Not Assessed
Motor Development: (This field is required for recipients 18 years of age or younger.) Select the
choice that best describes the recipient's motor development just prior to the time of transplant. (List of
Motor Development codes)
Definite Motor Delay/Impairment (verified by physical exam or unambiguous behavioral
observation)
Probable Motor Delay/Impairment (not verified or unambiguous but more likely than not, based
on behavioral observation or other evidence)
Questionable Motor Delay/Impairment (not judged to be more likely than not, but with some
indication of motor delay/impairment)
No Motor Delay/Impairment (no obvious indicators of motor delay/impairment)
Not Assessed
Working for income: (This field is required for recipients 19 years of age or older.) If the recipient is
working for income just prior to the time of transplant, select Yes. If not, select No. If unknown, select
UNK.
If No, Not Working Due To: If No is selected, indicate the reason why the candidate is not working
just prior to the time of transplant. (List of Not Work Reason codes)
Disability - A physical or mental impairment that interferes with or prevents a candidate from
working (e.g. arthritis, mental retardation, cerebral palsy, etc).
Demands of Treatment - An urgent medical treatment that prevents a candidate from working
(e.g. dialysis).
Insurance Conflict - Any differences between a candidate and insurance company that
prevents them from working.
Inability to Find Work - The lack of one's ability to find work (e.g. lack of transportation, work
experience, over qualification, unavailable work, etc.).
Patient Choice - Homemaker - A candidate who chooses to manage their own household,
instead of performing work for pay.

Patient Choice - Student Full Time/Part Time - A candidate who is enrolled and/or
participating in college.
Patient Choice - Retired - A candidate who no longer has an active working life such as an
occupation, business or office job.
Patient Choice - Other - Any reason not listed above that would prevent a candidate from
working.
Not Applicable - Hospitalized - Select only if the patient's Medical Condition indicates they
are in the hospital.
Unknown
If Yes: If Yes is selected, indicate the candidate's working status just prior to the time of transplant.
(List of Working codes)
Working Full Time
Working Part Time due to Demands of Treatment
Working Part Time due to Disability
Working Part Time due to Insurance Conflict
Working Part Time due to Inability to Find Full Time Work
Working Part Time due to Patient Choice
Working Part Time Reason Unknown
Working, Part Time vs. Full Time Unknown
Academic Progress: (This field is required for recipients less than 19 years of age.) Select the choice
that best describes the recipient's academic progress just prior to the time of transplant. If the candidate
is less than 5 years old or has graduated from high school, select Not Applicable < 5 years old/High
School graduate or GED. (List of Academic Progress codes)
Within One Grade Level of Peers
Delayed Grade Level
Special Education
Not Applicable <5 years old/High School graduate or GED
Status Unknown
Academic Activity Level: (This field is required for recipients less than 19 years of age.) Select the
choice that best describes the recipient's academic activity level just prior to the time of transplant. If the
recipient is less than 5 years old or has graduated from high school, select Not Applicable < 5 years
old/High School graduate or GED. (List of Academic Activity Level codes)
Full academic load
Reduced academic load
Unable to participate in academics due to disease or condition
Unable to participate regularly in academics due to dialysis
Not Applicable <5 years old/High School graduate or GED
Status Unknown
Source of Payment:
Primary: Select as appropriate to indicate the recipient's source of primary payment (largest
contributor) for the transplant. This field is required. (List of Primary Insurance codes)
Private insurance refers to funds from agencies such as Blue Cross/Blue Shield, etc. It also
refers to any worker's compensation that is covered by a private insurer.
Public insurance - Medicaid refers to state Medicaid funds.
Public insurance - Medicare FFS (Fee-for-Service) refers to funds from the government in
which doctors and other health care providers are paid for each service provided to a recipient.
For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.

Public insurance - Medicare & Choice (also known as Medicare Managed Care) refers to
funds from the government in which doctors and other health care providers are paid for each
service provided to a recipient, along with additional benefits such as coordination of care or
reducing-out-of-pocket expenses. Sometimes a recipient may receive additional benefits such
as prescription drugs. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - CHIP (Children's Health Insurance Program)
Public insurance - Department of VA refers to funds from the Veterans Administration.
Public insurance - Other government
Self indicates that the recipient will pay for the cost of transplant.
Donation indicates that a company, institution, or individual(s) donated funds to pay for the
transplant and care of the recipient.
Free Care indicates that the transplant hospital will not charge recipient for the costs of the
transplant operation.
Foreign Government, Specify refers to funds provided by a foreign government (Primary
only) Specify foreign country in the space provided. (List of Foreign Country codes)
Unknown
Secondary: Select check as appropriate to indicate the recipient's source of secondary payment.
(List of Secondary Insurance codes)
Private insurance refers to funds from agencies such as Blue Cross/Blue Shield, etc. It also
refers to any worker's compensation that is covered by a private insurer.
Public insurance - Medicaid refers to state Medicaid funds.
Public insurance - Medicare FFS (Fee-for-Service) refers to funds, from the government in
which doctors and other health care providers are paid for each service provided to a recipient.
For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - Medicare & Choice (also known as Medicare Managed Care) refers to
funds from the government in which doctors and other health care providers are paid for each
service provided to a recipient, along with additional benefits such as coordination of care or
reducing-out-of-pocket expenses. Sometimes a recipient may receive additional benefits such
as prescription drugs. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - CHIP (Children's Health Insurance Program)
Public insurance - Other government
Self indicates that the recipient will pay for the cost of transplant.
Donation indicates that a company, institution, or individual(s) donated funds to pay for the
transplant and care of the recipient.
Free Care indicates that the transplant hospital will not charge the recipient for the costs of the
transplant operation.
None - Select if the recipient does not have a secondary source of payment.
C linical Information: P retransplant

Date of Measurement: (Complete for recipients 18 years of age or younger.) Enter the date, using the
8-digit format of MM/DD/YYYY, the recipient’s height and weight were measured.
Height: Enter the height of the recipient, just prior to the time of transplant, in feet and inches or
centimeters. If the recipient’s height is unavailable, select the appropriate status from the ST field
(Missing, Unknown, N/A, Not Done). (List of Status codes) For recipients 18 years old or younger at
the time of transplant, UNet will generate and display calculated percentiles based on the 2000 CDC
growth charts. This field is required.
Weight: Enter the weight of the recipient, just prior to the time of transplant, in pounds or kilograms. If
the recipient’s weight is unavailable, select the appropriate status from the ST field (Missing,
Unknown, N/A, Not Done). (List of Status codes) For recipients 18 years old or younger at the time of
transplant, UNet will generate and display calculated percentiles based on the 2000 CDC growth
charts. This field is required.
BMI (Body Mass Index): The recipient's BMI will display. For candidates less than 20 years of age at
the time of transplant, UNet will generate and display calculated percentiles based on the 2000 CDC
growth charts.
Percentiles are the most commonly used clinical indicator to assess the size and growth patterns
of individual children in the United States. Percentiles rank the position of an individual by indicating
what percent of the reference population the individual would equal or exceed (i.e. on the weightfor-age growth charts, a 5 year-old girl whose weight is at the 25th percentile, weighs the same or
more than 25 percent of the reference population of 5-year-old girls, and weighs less than 75
percent of the 5-year-old girls in the reference population). For additional information about CDC
growth charts, see http://www.cdc.gov/.
Note: Users who check the BMI percentiles against the CDC calculator may notice a discrepancy
that is caused by the CDC calculator using 1 decimal place for height and weight and UNetsm using
4 decimal places for weight and 2 for height.
Previous Transplants: The three most recent transplant(s), indicated on the recipient's validated
Transplant Recipient Registration (TRR) record(s), will display. Verify all previous transplants listed by
organ type, transplant date and graft failure date.
Note: The three most recent transplants on record for this recipient will be displayed for verification. If
there are any prior transplants that are not listed here, contact the UNet Help Desk at 1-800-9784334 or [email protected] to determine if the transplant event is in the database.
Pretransplant Dialysis: If the recipient was on maintenance dialysis before transplant, select Yes. If
not, select No. If unknown, select UNK. This field is required.
If Yes, Date First Dialyzed: If the recipient was on maintenance dialysis before transplant, enter
the date that the recipient first began dialysis. If the date is unavailable, select the appropriate
status from the ST field (Missing, Unknown, N/A, Not Done). (List of Status codes)
Average Daily Insulin Units: Enter the recipient's average daily insulin in units. If the value is
unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A, Not Done). This
field is required. (List of Status codes)
Serum Creatinine at Time of TX: Enter the serum creatinine at the time of transplant in mg/dl. If the
value is unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A, Not
Done). This field is required. (List of Status codes)
Viral Detection:
HIV Serostatus: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not Done
UNK/Cannot Disclose

Definition: Human Immunodeficiency Virus - Any of several retroviruses and especially HIV-1
that infect and destroy helper T cells of the immune system causing the marked reduction in
their numbers that is diagnostic of AIDS.
CMV IgG: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not Done
UNK/Cannot Disclose
Definition: Cytomegalovirus - A herpesvirus (genus Cytomegalovirus) that causes cellular
enlargement and formation of eosinophilic inclusion bodies especially in the nucleus and that
acts as an opportunistic infectious agent in immunosuppressed conditions (as AIDS).
CMV IgM: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not Done
UNK/Cannot Disclose
Definition: Cytomegalovirus - A herpesvirus (genus Cytomegalovirus) that causes cellular
enlargement and formation of eosinophilic inclusion bodies especially in the nucleus and that
acts as an opportunistic infectious agent in immunosuppressed conditions (as AIDS).
HBV Core Antibody: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not Done
UNK/Cannot Disclose
Definition: Hepatitis B Virus - A sometimes fatal hepatitis caused by a double-stranded DNA
virus (genus Orthohepadnavirus of the family Hepadnaviridae) that tends to persist in the blood
serum and is transmitted especially by contact with infected blood (as by transfusion or by
sharing contaminated needles in illicit intravenous drug use) or by contact with other infected
bodily fluids (as during sexual intercourse) -- also called serum hepatitis.
HBV Surface Antigen: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not Done
UNK/Cannot Disclose
Definition: Hepatitis B Virus - A sometimes fatal hepatitis caused by a double-stranded DNA
virus (genus Orthohepadnavirus of the family Hepadnaviridae) that tends to persist in the blood
serum and is transmitted especially by contact with infected blood (as by transfusion or by
sharing contaminated needles in illicit intravenous drug use) or by contact with other infected
bodily fluids (as during sexual intercourse) -- also called serum hepatitis.
HCV Serostatus: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not Done
UNK/Cannot Disclose
Definition: Hepatitis C Virus - A disease caused by a flavivirus that is usually transmitted by
parenteral means (as injection of an illicit drug, blood transfusion, or exposure to blood or blood
products) and that accounts for most cases of non-A, non-B hepatitis.
EBV Serostatus: Select the serology results from the drop-down list. This field is required.

Positive
Negative
Not Done
UNK/Cannot Disclose
Definition: (Epstein-Barr Virus) - A herpesvirus (genus Lymphocryptovirus) that causes
infectious mononucleosis and is associated with Burkitt's lymphoma and nasopharyngeal
carcinoma -- abbreviation EBV; called also EB virus.
Malignancies between listing and transplant: If recipient had any malignancies between listing and
transplant, select Yes. If the recipient has not had any malignancies, select No. If Yes is selected,
indicate type of malignancy. If the recipient had a malignancy, but the type of malignancy is not listed,
select Other, specify and enter the name of the malignancy in the space provided. This field is
required. (List of Malignancy codes)
Skin Melanoma
Skin Non-Melanoma
CNS Tumor
Genitourinary
Breast
Thyroid
Tongue/Throat/Larynx
Lung
Leukemia/Lymphoma
Liver
Other, specify
Note: This question is NOT applicable for patients receiving living donor transplants who were
never on the waiting list.
C linical Information: Transplant Procedure
Multiple Organ Recipient: If the recipient received other organs, reported on the Recipient Feedback,
they will display. If the recipient didn't receive any other organs at this time, None is displayed. Verify
the other organs, transplanted at this time, are correct. If incorrect, contact the Help Desk.
Were extra vessels used in the transplant procedure: If extra vessels (vascular allografts) were
used in the transplant procedure, as indicated on the Waitlist Removal, YES displays.
Vessel Donor ID: The Donor ID entered on the Waitlist Removal displays.
Note: Donor IDs entered for this question must be from deceased donors. All deceased donor extra
vessels must be
monitored due to the potential for disease transmission.
Note: If the extra vessels used in a transplant procedure are procured from a tissue processing
organization, they are not reported in UNet.
Procedure Type: The procedure type, reported in the Recipient Feedback, will display. Verify the
information displayed in the Procedure Type field is correct. (List of Procedure Type codes)
Pancreas segment
Whole pancreas with duodenum
Whole pancreas with duodenal patch
Whole pancreas
Surgical Information:

If a simultaneous Tx with another organ, was the Pancreas revascularized before or after
other organs? Indicate if the pancreas was revascularized. If this surgery did not include a
simultaneous transplant with another organ, select Not Applicable. (List of Revascularized codes)
Before
Simultaneous
After
Not Applicable
Surgical Incision: Indicate the type of surgical incision. (List of Surgical Incision codes)
Left
Midline: Incision follows the midline of the abdomen.
Other
Right
Graft Placement: Indicate where the graft was placed during the transplant operation. This field is
required. (List of Graft Placement codes)
Intra-Peritoneal: Pancreas graft placed totally within the peritoneal cavity.
Retro-Peritoneal: Pancreas graft placed totally behind the peritoneum (extra peritoneal).
Partial Intra/Retro-Peritoneal: Pancreas placed retroperitoneally with the peritoneum then
opened.
Operative Technique: Indicate the type of pancreas transplant. This field is required. (List of
Operative Technique codes)
Pancreas Alone: The recipient only received a pancreas.
Cluster: The recipient received a pancreas with a least a whole liver. Other organs could also
have been transplanted.
Multi-Organ Non-Cluster: The recipient received a pancreas with any other organ(s) excluding
kidney and liver.
Pancreas After Kidney
Pancreas with Kidney Different Donor
Duct Management: Indicate the type of duct management used to manage the exocrine pancreatic
functions. This field is required. (List of Duct Management codes)
Enteric with Roux-en-y: The pancreatic duct is allowed to drain into the small intestine using a
Roux-en-y.
Enteric without Roux-en-y: The pancreatic duct is allowed to drain into the small intestine
without using a Roux-en-y.
Cystostomy: The pancreatic duct is allowed to drain into the bladder.
Duct Injection Immediate: A synthetic polymer is injected directly into the pancreatic duct
immediately after surgical revascularization.
Duct Injection Delayed: The duct is left open for a period up to 30 days before a synthetic
polymer is injected directly into the pancreatic duct.
Other Specify: If a type of duct management used is not listed, select Other and enter the type
of duct management in the space provided.
Venous Vascular Management: Indicate which venous system (systemic or portal) was used to
attach the pancreas. This field is required. (List of Vascular Management codes)
Systemic System (Iliac:Cava)
Portal System (Portal or Tributaries)
NA/Multi-organ cluster
Arterial Reconstruction: Indicate the type of arterial reconstruction used in the transplant
operation. This field is required. (List of Arterial Reconstruction codes)
Celiac Axis with Pancreas: The celiac axis remained attached to the pancreas and
reconstruction of the artery was not necessary.

Y-Graft to SpA and SMA: The splenic artery (SpA) and the superior mesenteric artery (SMA)
were attached via an arterial graft.
SpA Alone: The splenic artery alone.
SpA to SMA Direct: The splenic artery was anastomosed end-to-side to the superior
mesenteric artery.
SpA to SMA with Interposition: The splenic artery was attached to the superior mesenteric
artery with an interposition graft.
Other: If the type of arterial reconstruction is not listed, select Other and enter the type of
reconstruction used in the space provided.
Venous Extension Graft: If a venous extension graft was used to lengthen the portal or splenic
vein of the pancreas graft, select Yes. If not, select No. This field is required.
Preservation Information: The preservation information for the pancreas procedure type is displayed
for the recipient. Enter the Total Pancreas Preservation Time, in hours, for the pancreas procedure.
Total Pancreas Preservation Time (Include cold, warm and anastomotic time) is the time
between cessation of blood flow in the donor and revascularization of the pancreas in the recipient.
If the time is unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A,
Not Done). This field is required. (List of Status codes)
Note: Enter the time in hours and decimal parts of an hour. For example, 1 hour should be entered
as "1", "1.0" or "1.00"; 1 hour and 30 minutes should be entered as "1.5" or "1.50" not "1.30".
To report the minutes, divide the number of minutes into 60 and record 2 decimal places.
Example: 7hrs 19 minutes = 7.32 ( 60 divided by 19 =.32)
Clinical Information: Post Transplant
Pancreas Graft Status: Select the status that best describes the pancreas graft status. This field is
required.
Note: Select Functioning for the Pancreas Graft Status field if the patient was removed from the
waiting list with a code 21, indicating the patient died during the transplant procedure.
Note: If death is indicated for the recipient, and the death was a result of some other factor
unrelated to graft failure, select Functioning.
Functioning: The graft has sufficient function so that the recipient is NOT receiving any insulin or
medication for blood sugar control.
Partial Function: The patient is taking some insulin, but < 50% of the usual amount taken before
transplant, or C-Peptide is present.
Failed: The graft has totally failed and the patient is completely dependent upon insulin or oral
medication for blood sugar control.
Method of blood sugar control: If Partial Function or Failed is selected, check all that apply.
(List of Blood Sugar Control codes)
Insulin
Oral medication
Diet
No Treatment
Date insulin/medication resumed: If Insulin or Oral medication is selected, enter
the date using the standard 8 digit numeric format of MM/DD/YYYY.

If Failed is selected, complete the following fields:
Date of Graft Failure Pancreas: If the pancreas graft failed, enter the date of the failure
using the standard 8 digit numeric format of MM/DD/YYYY.
Note: The date of failure and the date insulin/medication was resumed should be the
same, unless the patient has a previous partial graft function reported.
Pancreas Graft Removed: If the pancreas graft had been removed, select Yes. If not,
select No. If unknown, select UNK.
If Yes, Date Pancreas Graft Removed: If the pancreas graft had been removed, enter
the date of removal.
Pancreas Primary Cause of Graft Failure: Select the primary cause of graft failure. If the
primary cause of graft failure is not listed, select Other Specify and enter the primary
cause of graft failure in the space provided. (List of Graft Failure codes)
Graft/Vascular Thrombosis
Infection
Bleeding
Anastomotic Leak
Primary Non-Function
Acute Rejection
Hyperacute Rejection
Biopsy Proven Isletitis
Pacreatitis
Other Specify
Contributory causes of graft failure: For each of the causes listed, select Yes, No, or
UNK to indicate whether each is a contributory cause of graft failure. Select NO for the
primary cause, since it cannot be both the primary and secondary cause of graft failure. If
Other is selected, specify the cause in the space provided.
Pancreas Graft/Vascular Thrombosis
Pancreas Infection
Bleeding
Anastomotic Leak
Hyperacute Rejection
Pancreas Acute Rejection
Biopsy Proven Isletits
Pancreatitis
Other
Pancreas Transplant Complications: (Not leading to graft failure.) For each of the complications
listed, indicate if the complication occurred prior to the recipient's hospital discharge. Do not select Yes
if the complication contributed to failure of the pancreas graft.
Pancreatitis: If the recipient has been diagnosed as having pancreatitis, select Yes. If not, select
No. If unknown, select UNK. This field is required.
Anastomotic Leak: If the recipient exhibits signs and symptoms of an anastomotic leak, select
Yes. If not, select No. If unknown, select UNK. This field is required.
Abscess or Local Infection: If the recipient exhibits signs and symptoms of abscess or local
infection, select Yes. If not, select No. If unknown, select UNK. This field is required.
Other: If a complication other than those listed occurred, specify the complication in the space
provided.
Did patient have any acute rejection episodes between transplant and discharge: If the recipient
had any acute rejection episodes between transplant and discharge, select a Yes choice. If not, select

No. If a Yes choice is selected, then indicate if a biopsy was done to confirm acute rejection. This field
is required. (List of Any Acute Rejection Episodes codes)
Yes, at least one episode treated with anti-rejection agent
Yes, none treated with additional anti-rejection agent
No
Was Biopsy done to confirm acute rejection: If the recipient had an acute kidney rejection
episode, indicate whether biopsy confirmed acute rejection by selecting Yes. If a biopsy was not
done, select Biopsy not done. If unknown, select Unknown. (List of Biopsy Confirmed codes)
Biopsy not done
Yes, rejection confirmed
Yes, rejection not confirmed
Treatment
Biological or Anti-viral Therapy: If biological or anti-viral therapy is being administered to the
recipient, select Yes. If not, select No. If unknown or can't disclose, select Unknown/Cannot Disclose.
If Yes is selected, check all that apply. If a therapy, other than those listed, was administered, select
Other, Specify and enter the therapy in the space provided. (List of Anti-viral Treatment codes)
Acyclovir (Zovirax)
Cytogam (CMV)
Gamimune
Gammagard
Ganciclovir (Cytovene)
Valgancyclovir (Valcyte)
HBIG (Hepatitis B Immune Globulin)
Flu Vaccine (Influenza Virus)
Lamivudine (Epivir) (for treatment of Hepatitis B)
Other, Specify
Valacyclovir (Valtrex)
Other Therapies: If the recipient received other therapies, select Yes. If not, select No. If Yes is
selected, check all that apply. (List of Other Therapies codes)
Photopheresis
Plasmapheresis
Total Lymphoid Irradiation (TLI)
Note: If the recipient was removed from the waiting list with a code 21, indicating the recipient died
during the transplant procedure, select No for all Biologicals or Anti-viral.
Immunosuppressive Information
Are any medications given currently for maintenance or anti-rejection: If medications have been
given to the recipient for maintenance or anti-rejection during the time between transplant and hospital
discharge, or 6 weeks post-transplant if the recipient has not been discharged, select Yes. If not, select
No. If Yes, complete the sections below. This field is required.
Did the recipient participate in any clinical research protocol for immunosuppressive
medications: If the recipient participated in clinical research for immunosuppressive medications,
select Yes. If not, select No. If Yes, specify in the space provided.

Immunosuppressive Medications
For each of the immunosuppressive medications listed, select Ind.(Induction), Maint (Maintenance) or
AR (Anti-rejection) to indicate all medications that were prescribed for the recipient during the initial
transplant hospitalization period, and for what reason. If a medication was not given, leave the
associated box blank.
Induction (Ind.) immunosuppression includes all medications given for a short finite period in the
perioperative period for the purpose of preventing acute rejection. Though the drugs may be
continued after discharge for the first 30 days after transplant, it will not be used long-term for
immunosuppressive maintenance. Induction agents are usually polyclonal, monoclonal, or IL-2
receptor antibodies (e.g., Methylprednisolone, Atgam, Thymoglobulin, OKT3, Simulect, or
Zenapax). Some of these drugs might be used for another finite period for rejection therapy and
would be recorded as rejection therapy if used for this reason. For each induction medication
indicated, enter the total number of days the drug was actually administered in the space provided.
For example, if Simulect or Zenapax was given in 2 doses a week apart then the total number of
days would be 2, even if the second dose was given after the patient was discharged.
Maintenance (Maint) includes all immunosuppressive medications given before, during or after
transplant for varying periods of time which may be either long-term or intermediate term with a
tapering of the dosage until the drug is either eliminated or replaced by another long-term
maintenance drug (e.g., Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil,
Azathioprine, or Rapamycin). This does not include any immunosuppressive medications given to
treat rejection episodes, or for induction.
Anti-rejection (AR) immunosuppression includes all immunosuppressive medications given for the
purpose of treating an acute rejection episode during the initial post-transplant period or during a
specific follow-up period, usually up to 30 days after the diagnosis of acute rejection (e.g.,
Methylprednisolone, Atgam, OKT3, or Thymoglobulin). When switching maintenance drugs (e.g.,
from Tacrolimus to Cyclosporine; or from Mycophenolate Mofetil to Azathioprine) because of
rejection, the drugs should not be listed under AR immunosuppression, but should be listed under
maintenance immunosuppression.
Note: As further clarification, drugs that are used with the intention to maintain recipients longterm are medications such as Tacrolimus, Cyclosporine, Azathioprine, Mycophenolate
Mofetil and Prednisone. These maintenance medications should not be listed as AR
medications to treat acute rejection. When patients have a true acute rejection, they are
given anti-rejection medication such as steroids, OKT3, ATG, Simulect and Zenapax, in
addition to the maintenance medications. These are the medications that should be
selected as anti-rejection.
If an immunosuppressive medication other than those listed is being administered (e.g., new
monoclonal antibodies), select Ind., Maint, or AR next to Other Immunosuppressive Medication
field, and enter the full name of the medication in the space provided. Do not list nonimmunosuppressive medications.
If the number of days is unavailable, select the appropriate status from the applicable Status field
(Missing, Unknown, N/A, Not Done). (List of Status codes)
Other Immunosuppressive Medications
For each of the immunosuppressive medications listed, select Ind.(Induction), Maint (Maintenance) or
AR (Anti-rejection) to indicate all medications that were prescribed for the recipient during the initial
transplant hospitalization period, and for what reason. If a medication was not given, leave the
associated box blank.

Induction (Ind.) immunosuppression includes all medications given for a short finite period in the
perioperative period for the purpose of preventing acute rejection. Though the drugs may be
continued after discharge for the first 30 days after transplant, it will not be used long-term for
immunosuppressive maintenance. Induction agents are usually polyclonal, monoclonal, or IL-2
receptor antibodies (e.g., Methylprednisolone, Atgam, Thymoglobulin, OKT3, Simulect, or
Zenapax). Some of these drugs might be used for another finite period for rejection therapy and
would be recorded as rejection therapy if used for this reason. For each induction medication
indicated, enter the total number of days the drug was actually administered in the space provided.
For example, if Simulect or Zenapax was given in 2 doses a week apart then the total number of
days would be 2, even if the second dose was given after the patient was discharged.
Maintenance (Maint) includes all immunosuppressive medications given before, during or after
transplant for varying periods of time which may be either long-term or intermediate term with a
tapering of the dosage until the drug is either eliminated or replaced by another long-term
maintenance drug (e.g., Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil,
Azathioprine, or Rapamycin). This does not include any immunosuppressive medications given to
treat rejection episodes, or for induction.
Anti-rejection (AR) immunosuppression includes all immunosuppressive medications given for the
purpose of treating an acute rejection episode during the initial post-transplant period or during a
specific follow-up period, usually up to 30 days after the diagnosis of acute rejection (e.g.,
Methylprednisolone, Atgam, OKT3, or Thymoglobulin). When switching maintenance drugs (e.g.,
from Tacrolimus to Cyclosporine; or from Mycophenolate Mofetil to Azathioprine) because of
rejection, the drugs should not be listed under AR immunosuppression, but should be listed under
maintenance immunosuppression.
Note: As further clarification, drugs that are used with the intention to maintain recipients longterm are medications such as Tacrolimus, Cyclosporine, Azathioprine, Mycophenolate
Mofetil and Prednisone. These maintenance medications should not be listed as AR
medications to treat acute rejection. When patients have a true acute rejection, they are
given anti-rejection medication such as steroids, OKT3, ATG, Simulect and Zenapax, in
addition to the maintenance medications. These are the medications that should be
selected as anti-rejection.
If an immunosuppressive medication other than those listed is being administered (e.g., new
monoclonal antibodies), select Ind., Maint, or AR next to Other Immunosuppressive Medication
field, and enter the full name of the medication in the space provided. Do not list nonimmunosuppressive medications.
If the number of days is unavailable, select the appropriate status from the applicable Status field
(Missing, Unknown, N/A, Not Done). (List of Status codes)
Investigational Immunosuppressive Medications
For each of the immunosuppressive medications listed, select Ind. (Induction), Maint (Maintenance)
or AR (Anti-rejection) to indicate all medications that were prescribed for the recipient during the initial
transplant hospitalization period, and for what reason. If a medication was not given, leave the
associated box blank.
Induction (Ind.) immunosuppression includes all medications given for a short finite period in the
perioperative period for the purpose of preventing acute rejection. Though the drugs may be
continued after discharge for the first 30 days after transplant, it will not be used long-term for
immunosuppressive maintenance. Induction agents are usually polyclonal, monoclonal, or IL-2
receptor antibodies (example: Methylprednisolone, Atgam, Thymoglobulin, OKT3, Simulect, or
Zenapax). Some of these drugs might be used for another finite period for rejection therapy and
would be recorded as rejection therapy if used for this reason. For each induction medication
indicated, enter the total number of days the drug was actually administered in the space provided.

For example, if Simulect or Zenapax was given in 2 doses a week apart then the total number of
days would be 2, even if the second dose was given after the patient was discharged.
Maintenance (Maint) includes all immunosuppressive medications given before, during or after
transplant for varying periods of time which may be either long-term or intermediate term with a
tapering of the dosage until the drug is either eliminated or replaced by another long-term
maintenance drug (e.g., Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil,
Azathioprine, or Rapamycin). This does not include any immunosuppressive medications given to
treat rejection episodes, or for induction.
Anti-rejection (AR) immunosuppression includes all immunosuppressive medications given for the
purpose of treating an acute rejection episode during the initial post-transplant period or during a
specific follow-up period, usually up to 30 days after the diagnosis of acute rejection (example:
Methylprednisolone, Atgam, OKT3, or Thymoglobulin). When switching maintenance drugs
(example: from Tacrolimus to Cyclosporine; or from Mycophenolate Mofetil to Azathioprine)
because of rejection, the drugs should not be listed under AR immunosuppression, but should be
listed under maintenance immunosuppression.
Note: As further clarification, drugs that are used with the intention to maintain recipients longterm are medications such as Tacrolimus, Cyclosporine, Azathioprine, Mycophenolate
Mofetil and Prednisone. These maintenance medications should not be listed as AR
medications to treat acute rejection. When patients have a true acute rejection, they are
given anti-rejection medication such as steroids, OKT3, ATG, Simulect and Zenapax, in
addition to the maintenance medications. These are the medications that should be
selected as anti-rejection.
If an immunosuppressive medication other than those listed is being administered (e.g., new
monoclonal antibodies), select Ind., Maint, or AR next to Other Immunosuppressive Medication
field, and enter the full name of the medication in the space provided. Do not list nonimmunosuppressive medications.
If the number of days is unavailable, select the appropriate status from the applicable Status field
(Missing, Unknown, N/A, Not Done). (List of Status codes)
Drug Codes (List of Drug Codes)
Immunosuppressive Medications
Steroids (Prednisone,Methylprednisolone,Solumedrol,Medrol,Decadron)
Atgam (ATG)
OKT3 (Orthoclone, Muromonab)
Thymoglobulin
Simulect - Basiliximab
Zenapax - Daclizumab
Azathioprine (AZA, Imuran)
EON (Generic Cyclosporine)
Gengraf (Abbott Cyclosporine)
Other generic Cyclosporine, specify brand:
Neoral (CyA-NOF)
Sandimmune (Cyclosporine A)
CellCept (Mycophenolate Mofetil; MMF)
Generic MMF (Generic CellCept)

Prograf (Tacrolimus, FK506)
Generic Tacrolimus (Generic Prograf)
Modified Release Tacrolimus FK506E (MR4)
Sirolimus (RAPA, Rapamycin, Rapamune)
Myfortic (Mycophenolate Sodium)
Other Immunosuppressive Medications
Campath - Alemtuzumab (anti-CD52)
Cyclophosphamide (Cytoxan)
Leflunomide (LFL, Arava)
Methotrexate (Folex, PFS, Mexate-AQ, Rheumatrex)
Other Immunosuppressive Medication, Specify
Rituximab
Investigational Immunosuppressive Medications
Everolimus (RAD, Certican)
Other Immunosuppressive Medication, Specify