Kidney/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 Policy 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 1-800-978-4334.
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 (location of full-time residence, not transplant center location). This field is required. (List of State codes – See Appendix A)
Permanent Zip code: Enter the recipient's permanent zip code at the time of transplant (location of full-time residence, not transplant center location). This field is required.
Provider Information
Recipient Center: The Recipient Center information reported in Waitlist displays. Verify that the center information is the hospital where the transplant operation was performed. The Provider Number is the 6-character Medicare identification number of the hospital. This is followed by the Center Code and Center Name.
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.
Surgeon NPI #: Enter the 10-character CMS (Center for Medicare and Medicaid Services) assigned National Provider Identifier of the transplant surgeon. 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
Kidney Primary Diagnosis: Select the primary diagnosis for the disease requiring a kidney transplant for this recipient. If the recipient has had a previous transplant for the same organ type, select 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 Kidney Diagnosis codes – See Appendix I)
Pancreas Primary Diagnosis: Select the primary diagnosis for the disease requiring a pancreas 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 – Appendix O)
Date: Last Seen Retransplanted or Death: Complete at discharge (if discharged prior to six weeks from transplant date) or at six weeks from transplant date, whichever occurs first. 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: Complete at discharge (if discharged prior to six weeks from transplant date) or at six weeks from transplant date, whichever occurs first. Select the appropriate status for this recipient. If Dead is selected, indicate the cause of death. This field is required.
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 – Appendix Q)
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 Causes of Death – See Appendix Q)
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 Causes of Death – See Appendix Q)
Note: If the Patient Status is Retransplanted, then Failed must be selected for both the Kidney Graft Status and 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 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 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.
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.
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.
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 Score will display for pediatrics aged less than 18.
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.
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.
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.
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.
Academic Progress: (This field is required for recipients less than 18 years of age.) Select the choice that best describes the recipient's academic progress 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.
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 18 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.
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
Kidney 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.
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 – See Appendix E)
Pancreas 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.
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 – See Appendix E)
Secondary: Select check as appropriate to indicate the recipient's source of secondary payment.
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.
Clinical Information: PRETRANSPLANT
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). 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). 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 weight-for-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 UNet 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 1-800-978-4334 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 of Most Recent Initiation of Chronic Maintenance Dialysis: If the recipient was on maintenance dialysis before transplant, enter the date of most recent initiation of chronic maintenance dialysis. If the date is unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A, Not Done).
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.
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.
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 Status: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not
Done
UNK/Cannot DiscloseHBV 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 Antibody Total: Select the serology results from the drop-down list. This field is required.
Positive
Negative
Not
Done
UNK/Cannot Disclose
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.
Tolerance Induction: Before a transplant occurs the immune system can be prepared for the upcoming graft by attempting to induce graft tolerance. This can be achieved through a variety of protocols. The following are examples of tolerance induction protocols from the Primer on Transplantation 1-4)*:
Administration of moAbs (monoclonal antibodies) targeting cell surface molecules such as CD4, CD8, CD25, LFA-1, or the TCR (T-cell receptor)
Blockade of the costimulation pathways of T cell activation
Institution of pharmacological drug including steroids, rapamycin, cyclosporine
Donor specific transfusion
Combinations of immunosuppressive drugs and plasmaphoresis to decrease the recipient PRA in living donor transplants (member example)
* Norman, Douglas J., Turka, Laurence A. Primer on Transplantation, Second Edition page 40, American Society of Transplantation 2001
Previous Pregnancies: (This field will not display for male recipients.) For female recipients, select the number of previous pregnancies. Previous pregnancies include pregnancies which may or may not have resulted in live births. If the information is unknown, select Unknown. This field is required for all adult female recipients only.
No
Previous Pregnancy
1 Previous Pregnancy
2 Previous
Pregnancies
3 Previous Pregnancies
4 Previous Pregnancies
5
Previous Pregnancies
More than 5 Previous Pregnancies
Not
Applicable: < 10 years old
Unknown
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.
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.
Bone Disease (check all that apply): (Complete for recipients less than 18 years of age.)
Fracture in the past year: If the recipient had any fractures in the past year, select Yes. If not, select No. If unknown, select UNK. This field is required.
If Yes is selected, specify the location and number of fractures ( If Yes is selected, this field is required.)
Spine-compression
fracture: #of
fractures:
Extremity: #
of fractures:
Other:
#
of
fractures:
AVN (avascular necrosis): If the recipient has AVN at the time of transplant, select Yes. If not, select No. If unknown, select UNK. This field is required for recipients less than 18 years of age.
Clinical 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 tx 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.
LEFT KIDNEY
RIGHT KIDNEY
EN-BLOC
Sequential Kidney
Pancreas Segment
Whole Pancreas with Duodenum
Whole Pancreas with Duodenal Patch
Whole Pancreas
Pancreas segment / Kidney Right
Pancreas segment / Kidney Left
Pancreas segment / En-bloc Kidney
Pancreas Segment/Sequential Kidney
Whole pancreas with duodenum / left kidney
Whole pancreas with duodenum / right kidney
Whole pancreas with duodenum / en-bloc kidneys
Pancreas with duodenum/sequential kidney
Whole pancreas with duodenal patch / left kidney
Whole pancreas with duodenal patch / right kidney
Whole pancreas with duodenal patch / en-bloc kidneys
Pancreas with duodenal patch/sequential kidney
Whole pancreas / left kidney
Whole pancreas / right kidney
Whole pancreas / en-bloc kidneys
Whole
pancreas/sequential kidney
Surgical Information:
Graft Placement: Indicate where the graft was placed during the transplant operation. This field is required.
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 retro-peritoneally with the peritoneum then opened.
Operative Technique: Indicate the type of pancreas transplant. This field is required.
Simultaneous
Kidney-Pancreas:
The recipient received a simultaneous kidney pancreas.
Cluster:
The recipient received a pancreas with at 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.
Duct Management: Indicate the type of duct management used to manage the exocrine pancreatic functions. This field is required.
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.
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.
Celiac
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
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.
SpA
Alone:
The splenic artery alone.
Other Specify: 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.
Kidney and Pancreas Preservation Information:
Note:
When entering time in hours, 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. For example: 7 hours and 19 minutes = 7.32 (60
divided by 19 = 0.32)
-OR-
Total Cold Ischemia Time Left KI (OR EN-BLOC): (if pumped, include pump time): If the recipient's Procedure Type is Single Left, or Sequential, enter the Total Cold Ischemia Time for the left kidney, in hours, (if pumped, include pump time). If the time is unavailable, select the status from the ST field (Missing, Unknown, N/A, Not Done). This field is required.
Total Cold Ischemia Time is the number of hours between the time preservation of the organ begins and the time the organ was removed from cold storage.
-OR-
Total Pancreas Preservation Time (include cold, warm, and anastomotic time): The preservation information for the pancreas procedure type is the time between cessation of blood flow in the donor and revascularization of the pancreas in the recipient. Enter the time in hours. If the time is unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A, Not Done). This field is required.
Kidney(s) received on: Indicate whether the transplanted organs were received on Ice or Pump. For recipients of a living donor transplant, N/A is also an option. If received on ice, indicate whether the organ(s) Stayed on ice or were Put on pump. If received on pump, indicate whether the organ(s) Stayed on pump or were Put on ice. This field is required.
Note: Select N/A from the ST field for all Preservation Information if the recipient was removed from the waiting list with a code 21, indicating the recipient died during the transplant procedure.
If put on pump or stayed on pump: If the organs were pumped, indicate the Final resistance at transplant and Final flow rate at transplant in the spaces provided. This field will not display if transplanted organs were received on Ice and Stayed on ice. If final resistance is unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A, Not Done).
Clinical Information: Post Transplant
Kidney Graft Status: If the kidney graft is functioning, select Functioning. If the graft is not functioning at the time of hospital discharge or time of report, select Failed. If Failed, complete the remainder of this section. This field is required.
Note: Select Functioning if the recipient was removed from the waiting list with a code 21, indicating the recipient 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.
Resumed Maintenance dialysis: If the recipient returned to maintenance dialysis, select Yes. If not, select No.
Date Maintenance Dialysis Resumed: If the recipient returned to maintenance dialysis, enter the date maintenance dialysis was resumed using the standard 8-digit numeric format of MM/DD/YYYY.
Note: You may re-sort your Provider or Center results by clicking the designated red drop-down arrow.
If Failed is selected, complete the following fields:
Kidney Date of Graft Failure: Enter the date of graft failure using the standard 8-digit numeric format of MM/DD/YYYY.
Kidney 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 Cause and enter the primary cause of graft failure in the space provided.
Hyperacute
Rejection
Acute Rejection
Primary Failure
Graft
Thrombosis
Infection
Surgical Complications
Urological
Complications
Recurrent Disease
Other Specify Cause
Did patient have any acute kidney 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.
Yes,
at least one episode treated with anti-rejection agent
Yes, none
treated with additional anti-rejection agent
No
Is growth hormone therapy used between listing and transplant: If growth hormone therapy was used select Yes. If not, select No. If unknown, select UNK. This field is required for recipients less than 18 years of age.
Most Recent Serum Creatinine Prior to Discharge: Enter the most recent serum creatinine value in mg/dl available prior to the recipient's discharge from the hospital. Enter a number between 0.1 and 25.0. If the value is unavailable, select the appropriate status from the ST field (Missing, Unknown, N/A, Not Done). This field is required.
Patient Need dialysis within First Week: If the recipient required any dialysis within the first 7 days following the transplant operation, select Yes. If not, select No. This field is required.
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.
Insulin
Oral
medication
Diet
No Treatment
Date Insulin/Medication First 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:
Pancreas Date of Graft Failure: Enter the date of graft 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 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.
Graft/Vascular
Thrombosis
Infection
Bleeding
Anastomotic Leak
Primary
Non-Function
Acute Rejection
Hyperacute Rejection
Biopsy
Proven Isletitis
Pancreatitis
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
Isletitis
Pancreatitis
Other
Did patient have any acute pancreas 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.
Yes,
at least one episode treated with anti-rejection agent
Yes, none
treated with additional anti-rejection agent
No
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.
Weight Post Transplant: Enter the recipient's weight, at the time of discharge, in pounds or kilograms. If the recipient's weight is not available, select the appropriate status from the ST field (Missing, Unknown, N/A, Not Done). This field is required.
Treatment
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.
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 long-term 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 non-immunosuppressive medications.
If the number of days is unavailable, select the appropriate status from the applicable Status field (Missing, Unknown, N/A, Not Done).
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 long-term 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 non-immunosuppressive medications.
If the number of days is unavailable, select the appropriate status from the applicable Status field (Missing, Unknown, N/A, Not Done).
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 long-term 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 non-immunosuppressive medications.
If the number of days is unavailable, select the appropriate status from the applicable Status field (Missing, Unknown, N/A, Not Done).
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)
Nulojix (Belatacept)
Astagraf XL (Extended Release Tacrolimus)
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
Zortress (Everolimus)
Other Immunosuppressive Medication, Specify
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Carly D. Engelberger |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |